High prevalence of hepatitis B-antibody loss and a case report of de novo hepatitis B virus infection in a child after living-donor liver transplantation

Table 1 Patients’ demographic data and characteristics mean ± SD or n (%)

Characteristics	All participants (n = 50)
Age (yr)	6.67 ± 4.63
Age at liver transplantation (yr)	3.06 ± 3.97
Gender - female	27 (54)
Before liver transplantation
Anti-HBs level (IU/L)	584.41 ± 415.45
Anti-HBc positive	1 (2)
After liver transplantation
Anti-HBs level (IU/L)	58.56 ± 6.40
Length of stay in hospital after transplant (d)	44.10 ± 29.30
ABO incompatibility	3 (6)
PELD/MELD score	18.38 ± 8.47/15 (11-19)
Time since transplantation (yr)	2.53 ± 2.11
Medical complications
Acute rejection	22 (44)
Cytomegalovirus infection	15 (30)
Posttransplant lymphoproliferative disorder	14 (28)
De novo hepatitis B infection	1 (2)
De novo food allergy	9 (18)
Surgical complications
Vascular stricture	20 (40)
Biliary stricture	12 (24)
Chylous ascites/chylothorax	7 (14)
Donor characteristics
Gender - female	22 (44)
Cadaveric	6 (12)
Living	44 (88)
Anti-HBs
Negative	13 (26)
Positive
1-9 IU/L	30 (60)
> 10 IU/L	7 (14)
Anti-HBc positive	6 (12)

PELD: Pediatric end-stage liver disease; MELD: Model for end-stage liver disease.

Table 2 Nutritional and laboratory results of pre and post liver transplantation mean ± SD or n (%)

	Pre-transplantation	Post-transplantation		P value
		Short-term (3 mo)	Long-term
Body weight (kg)	11.66± 8.01	-	21.32 ± 12.07	< 0.001
Height (meter)	0.81 ± 0.23	-	1.07 ± 0.28	< 0.001
BMI (kg/m2)	16.59 ± 1.67	-	16.63 ± 2.71	0.76
Complete blood count
White blood cell (/μL)	10492 ± 4627	8559 ± 2495	7729 ± 3843	0.002
Neutrophil (/μL)	4938 ± 2565	3385 ± 1679	3418 ± 1912	< 0.001
Lymphocyte (/μL)	4263 ± 2222	3982 ± 1722	3109 ± 1762	0.01
Platelet (/μL)	172880 ± 94557	199720 ± 82777	233957 ± 94136	0.005
Liver function test
Total bilirubin(mg/dL)	18.50 ± 12.68	2.41 ± 0.91	0.84 ± 0.91	< 0.001
Direct bilirubin (mg/dL)	13.41 ± 10.28	0.83 ± 0.71	0.38 ± 0.51	< 0.001
Albumin (g/dL)	3.29 ± 0.97	3.94 ± 0.48	4.08 ± 0.35	< 0.001
Number of immunosuppressant
0	0		1 (2)
1	5 (10)		27 (54)	< 0.001
2	23 (46)		17 (34)
3	22 (44)		5 (10)

BMI: Body mass index.

Table 3 Potential factors associated with immunity in participants with HBV immunity and immunity loss mean ± SD or n (%)

	Nonimmunity (n = 30)	Immunity (n = 20)	P value
Age (yr)	7.60 ± 4.98	5.27 ± 3.74	0.08
Age at liver transplantation (yr)	3.71 ± 4.78	2.09 ± 2.03	0.11
Gender:Female	15 (50)	12 (60)	0.58
Body weight (kg)	13.07 ± 9.91	9.56 ± 2.74	0.07
Height (m)	0.85 ± 0.28	0.75 ± 0.12	0.09
Body mass index (kg/m2)	16.45 ± 1.62	16.45 ± 1.62	0.47
Anti-HBs level before transplantation (IU/L)	441.39 ± 408.88	798.94 ± 330.47	0.24
Length of hospital stay after transplantation (d)	47.77 ± 34.89	38.80 ± 17.45	0.24
PELD/MELD score	20.19 ± 8.50 (n = 28)	15.90 ± 7.98 (n = 19)	0.09
Time since transplant to anti-HBs testing (yr)	2.83 ± 2.00	2.06 ± 2.22	0.22
Donor characteristics
Gender: Female	14 (47)	8 (40)	0.43
Living	26 (87)	18 (90)	0.54
Medical complication
Acute rejection	11 (37)	11 (55)	0.16
CMV infection	6 (20)	9 (45)	0.11
PTLD	7 (23)	7 (35)	0.28
De novo hepatitis B	1 (3)	0 (0)	0.65
De novo food allergy	5 (16)	4 (20)	0.52
Surgical complication
Vascular stricture	13 (43)	7 (35)	0.39
Biliary stricture	8 (27)	4 (20)	0.46
Chylous ascites/chylothorax	5 (17)	2 (10)	0.41
Laboratory data before transplantation
White blood cell (/µL)	10237 ± 4167	10875 ± 5334	0.63
Neutrophil (/µL)	4780 ± 2137	5174 ± 3145	0.60
Lymphocyte (/µL)	4372 ± 2515	4100 ± 1742	0.65
Platelet (/µL)	159366 ± 99431	193156 ± 85132	0.22
Total bilirubin (mg/dL)	22.80 ± 13.72	12.04 ± 7.37	0.003
Direct bilirubin (mg/dL)	16.51 ± 11.37	8.73 ± 6.08	0.001
Albumin (g/dL)	3.07 ± 0.65	3.63 ± 1.25	0.04
Laboratory data 3 mo after transplantation
White blood cell (/µL)	8312 ± 2596	8931 ± 3440	0.64
Neutrophil (/µL)	3221 ± 1307	3630 ± 2136	0.45
Lymphocyte (/µL)	3879 ± 1851	4136 ± 1542	0.61
Platelet (/µL)	193300 ± 86221	208600 ± 78591	0.53
Albumin (g/dL)	3.96 ± 0.51	3.91 ± 0.44	0.72
Total bilirubin (mg/dL)	0.99 ± 1.12	0.59 ± 0.35	0.07
Direct bilirubin (mg/dL)	0.37 ± 0.15	0.32 ± 0.17	0.12
Laboratory data after long-term transplantation
White blood cell (/µL)	7114 ± 2845	8815 ± 5083	0.22
Neutrophil (/µL)	3196 ± 1412	3809 ± 2576	0.38
Lymphocyte (/µL)	3039 ± 1553	3232 ± 2128	0.72
Platelet (/µL)	217033 ± 87395	263823 ± 100739	0.12
Albumin (g/dL)	4.12 ± 0.35	4.00 ± 0.35	0.26
Total bilirubin (mg/dL)	0.98 ± 1.10	1.10 ± 0.31	0.08
Direct bilirubin (mg/dL)	0.45 ± 0.62	0.25 ± 0.13	0.20
Immunosuppressant 3 mo after transplantation
None	0	0
1	3 (10)	2 (10)	0.41
2	16 ((53)	7 (35)
3	11 (37)	11 (50)
Immunosuppressant after long-term liver transplantation
None	1 (3)	0
1	17 (56)	10 (50)	0.77
2	9 (30)	8 (40)
3	3 (10)	2 (10)

PELD: Pediatric end-stage liver disease; MELD: Model for end-stage liver disease; PTLD: Post-transplantation lymphoproliferative disease.