The Sources And Implication Of Detected Anti-HBs In Recipient Without HBIG-prophylaxis After Liver Transplantation

Objective: To investigate the sources and implication of detected anti-HBs in recipient without HBIG prophylaxis after liver transplantation. Methods: Those serial serum samples obtained from 50 recipients have been collected and tested with Roche Elecsys Anti-HBs Immunoassay. The alternations of serum anti-HBs titers have been described and the sources have been traced. Results: Anti-HBs is detectable in 38 of total 50 recipients (76%), the medium anti-HBs titer is 171±364IU/L one week postoperatively; 28 of those 40 (76%) HBV related disease recipients shown serum anti-HBs positive and the mean value of serum anti-HBs titer is 279.2±335.6IU/L within one week postoperatively. Serum anti-HBs positive in 16 of 24 active HBV replicating recipients (68%)has been demonstrated also and the average serum anti-HBs is as high as 368.33±376.5IU/L. Those serum anti-HBs titer mentioned as above declined gradually to below 100IU/L after 24 weeks. The dynamic alternation of the serum anti-HBs titer in accordance with postoperative duration as fellow, 186.87±226.7IU/L, 181.74±284.8IU/L, 122±194.9IU/L, 67.16±194.6IU/L and 73.59±241.2IU/L match for2, 4,12, 24 and 48 weeks postoperatively respectively. The origin of serum three sites: 7 recipients with acquired immunization to HBV previously, 1 recipient developed active immunity to HBV postoperatively, 30 recipients acquired passive infused anti-HBs with donated blood and certain kind of blood products intra and postoperatively. In the context, we have surveyed the blood donor and commerciallyavailable blood products, e.g. human serum globulin and human albumin, and demonstrated that over 60% blood donors and human serum globulin were potential sources of detected serum anti-HBs in our recipients. Their medium value of serum anti-HBs titers was 150IU/L and 1000IU/L respectively. Univariate analysis (Fisher Probability) demonstrated that HBV replicating status did not correlate with present of anti-HBs or not. In our previous clinical control study of Lamivudine monoprophylaxis for preventing HBV recurrence only one recipient (1/22, 4.5%) experienced HBV reinfection 2 years after LTX and 13 of enrolled 22 (59%) recipients really achieved serological and histological clearance of HBV markers during 1-3 years fellow-up. Therefore the detected anti-HBs in most of our recipients really contribute to our clinical outcome. Conclusions: 76 percent of LTx recipients acquired anti-HBs protection through infusion of donated blood and blood products intra or postoperatively in a variety of phase, usually 6 months. This kind of protective anti-HBs incorporated with Lamivudine prophylaxis has played a key role in preventing our LTx recipients from reinfection of HBV after LTx. On the hand, in terms of timing, duration and dose of HBIG used for preventing HBV recurrence should rely on the quantify of anti-HBs titers in individuals.