Hepatitis B seroconversion after allogeneic blood stem cell transplant

초록

Hepatis B is prevalent in many countries in Asia. Reactivation of hepatitis B in recipients or infection of hepatitis B from donors has been reported to be uncommon although worrisome. Seroconversion of recipients has been also reported in case of allogeneic blood stem cell transplant from seropositive donors. We have searched the cases of seroconversion among 113 cases of allogeneic blood stem cell transplant performed at the Inha University Hospital. A total of 113 pairs of recipients and donors for allogeneic blood stem cell transplant were reviewed from which data regarding hepatitis B serology were retrieved. Hepatitis B surface antigen/antibody assay was done by chemiluminescence immunoassay, using the Architect i2000 system (Abbott Laboratories, Abbott Park, IL). Post transplant serology of the recipient was unavailable in 46 cases (death, omission of the test, or lost to follow up) and data of 67 pairs were available. There were no HBV carriers among donors; 21 were seronegative and 25 had HBV antibody. There were five HBV carriers among recipients; 22 were seronegative and 40 had HBV antibody. Two HBsAg positive recipients showed seroconversion with loss of HBsAg and gain of HBsAb, one from seronegative donor and the other from HBsAb positive donor. Twelve seronegative recipient gained HBsAb, 8 from HBsAb positive donors and 4 from seronegative donors. Seven seropositive patients lost HBsAb, 3 recipients from HBsAb positive donors and 4 from HBsAb negative donors. Reverse seroconversion occurred in one patient who was transplanted from HBsAb positive donor. Twenty two of 67 allogeneic blood stem cell transplant recipients (33%) showed alteration in their serology against HBV. Adoptive seroconversion was noted in 2 of 5 HBV carriers (40%). For further refined study, prospective study design and serial quantitative titration of HBsAb are needed.