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Control of hepatitis B virus infection in hematopoietic stem cell recipients after receiving grafts from vaccinated donors

Bone Marrow Transplantation volume 51, pages 428–431 (2016)Cite this article

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Protection of hematopoietic stem cell recipients from infection remains challenging because of severe immunosuppression after transplantation. In patients with hepatitis B virus (HBV) infection prior to transplantation, the risk of HBV reactivation 5 years after transplantation was 70–86%.1, 2 To overcome HBV reactivation, active immunization of donors and early post-transplant vaccination of recipients has been suggested.3, 4 This recommendation is based on the fact that adoptive immune transfer from HBV-vaccinated donors was detected after hematopoietic stem cell transplantation.3, 5, 6, 7, 8, 9 However, protection from reactivation depended on vigorous HBV immunity in the donor.3, 10 Therefore, donors should optimally receive more than one immunization, a rather high Ag dose and a highly immunogenic vaccine. As clearance from HBV infection is dependent on effective T-cell immunity, the protection of recipients can be estimated better if their HBV-specific cellular immune response is known. However, cellular HBV immunity had not been determined in a previous study showing that donor vaccination can control HBV infection in hematopoietic stem cell recipients.3

We here present two effective strategies to select the optimal donor for hematopoietic stem cell recipients at risk of HBV reactivation or persistence of chronic HBV infection. Donors could either be electively vaccinated with highly immunogenic vaccines (for example, third generation vaccines containing PreS1, PreS2 and S HBV Ags11) or donors with strong HBV immunity after vaccination could be selected. Our study was approved by the local ethics committee and was conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from all subjects.

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Acknowledgements

The third generation vaccine Bio-Hep-B was kindly provided by Berna Biotech, the European distributor of SciGen Ltd (Sci B Vac). We are grateful to Monika Huben, Martina Praast and Sabine Wortmann for their excellent technical assistance.

Author contributions

ML, MR, MF, MK and DWB were involved in the conception and design of the study. MK, HDO and HDB provided patient samples. ML, MK, MF, AS and FMH were involved in the collection and assembly of data. ML and AS were involved in data analysis and interpretation. ML and PAH wrote the manuscript. All the authors gave final approval of the manuscript.

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Authors and Affiliations

  1. Institute for Transfusion Medicine, University Hospital, Essen, Germany

    M Lindemann, A Schumann, F M Heinemann & P A Horn

  2. Department of Bone Marrow Transplantation, University Hospital, Essen, Germany

    M Koldehoff, H D Ottinger & D W Beelen

  3. Institute of Virology, University Hospital, Essen, Germany

    M Fiedler, A Schumann & M Roggendorf

  4. Department of Clinical Chemistry, University Hospital, Essen, Germany

    A Schumann

Authors
  1. M Lindemann
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  2. M Koldehoff
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  3. M Fiedler
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  4. A Schumann
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  5. H D Ottinger
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  6. F M Heinemann
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  7. M Roggendorf
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  8. P A Horn
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  9. D W Beelen
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Corresponding author

Correspondence to M Lindemann.

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The authors declare no conflict of interest.

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Lindemann, M., Koldehoff, M., Fiedler, M. et al. Control of hepatitis B virus infection in hematopoietic stem cell recipients after receiving grafts from vaccinated donors. Bone Marrow Transplant 51, 428–431 (2016). https://doi.org/10.1038/bmt.2015.253

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