Abstract
Purpose
Hepatitis B is a major prognostic factor after hematopoietic stem cell transplantation (HSCT). Currently, there is a lack of consensus on the management of the broader spectrum of situations that can lead to reverse seroconversion of hepatitis B surface antigen (HBsAg-RS). Here, we focused on HBsAg-RS, a warning sign of active hepatitis development, and sought to obtain exploratory information on patient and treatment factors associated with it.
Methods
We conducted a single-center retrospective study using clinical data extracted from the electronic medical records of Seoul St. Mary’s Hospital, Korea. Patients who underwent HSCT between January 2013 and December 2018 and were hepatitis B surface antigen (HBsAg)-negative before HSCT were included. The associations of HBsAg-RS with demographic information, baseline hepatitis B serologic markers, and vaccination status were statistically analyzed.
Results
This study included 1,344 patients, of whom 83.3% tested positive for hepatitis B surface antibody (HBsAb) at the time of HSCT. HBsAg-RS occurred in 2.2% of HBsAb-negative patients and 3.0% of HBsAb-positive patients, indicating no significant difference in reactivation rates by HBsAb status. However, testing positive for the hepatitis B core antibody (HBcAb) was significantly associated with hepatitis B virus reactivation (HBsAg-RS rate, 8.0%). Vaccination rates were highest in patients who were negative for both HBsAb and HBcAb, and they had a transient protective effect.
Conclusion
The adequate patient population analyzed allowed us to identify an association between baseline HBcAb positivity and the development of HBsAg-RS. The need for prospective studies on appropriate vaccination methods to prevent HBsAg-RS is suggested.