Changes in hepatitis B virus serology in bone marrow transplanted children Bone marrow transplantation (BMT) is the treatment of choice for some malignant diseases, and acquired or congenital non-malignant disor- ders such as aplastic anemia and immunodefi- ciency disorders (1). The preparative regimen, development of graft-vs.-host disease (GVHD) and immunosuppression in allogeneic stem cell transplantation, suppress the host’s immune system (2). Suppression of the recipient’s immune system and reconstitution with the donor’s immune system may influence the status of chronic viral infections in the recipients (3). It is known that hepatitis B infection is an important complication after BMT. On one hand, immunosuppression may cause a reactiva- tion of hepatitis B virus (HBV) infection in the host in two ways (4–6). First, a previously inactive hepatitis B surface antigen (HBsAg) carrier recipient may develop fulminant hepatitis during immune reconstitution after transplanta- tion (7). However, some authors suggest that HBsAg carrier state is not a definite contraindi- cation for BMT (8, 9). Second, a patient sero- negative for HBV may acquire the infection from an HBsAg positive donor (3, 10). On the other hand, immunity obtained from a donor who is immune against HBV may cause HBV clearance and seroconversion from HBsAg to anti-HBs in the recipient (11–14). In this study, we retrospectively evaluated the changes in HBV serology after BMT in children. Patients and method A total of 77 children had received BMT in Hacettepe University Ihsan Dogramacı Children’s Hospital between 1995 and 2001. Their files were evaluated retrospectively and recipients whose HBV serology before and at least Ku¨ peli S, O ¨ zen H, Uc¸kan D, C¸ etin M, Tuncer M, Aypar E, Tezcan I. Changes in hepatitis B virus serology in bone marrow transplanted children. PediatrTransplantation2002:6:406–410. Ó 2002BlackwellMunksgaard Abstract: Suppression of the immune system and reconstitution of the donor’s immune system may affect the course of a chronic viral infec- tion in the recipients. The aim of this study is to evaluate changes in hepatitis B virus (HBV) serology after bone marrow transplantation (BMT). HBV serology and hepatic function tests were examined in 45 children before and after BMT. Before BMT, 40 patients were HBsAg negative and 5 positive. There were no HBsAg positive donors. HBsAg disappeared in two patients and anti-HBs became positive in one. Donors of these patients were anti-HBs positive. In a third patient, acute HBV infection developed and lasted without complication. This patient also seroconverted to anti-HBs. Anti-HBs disappeared in 7 of 21 anti-HBs positive patients. Among 18 patients who were HBsAg and anti-HBs negative, 11 seroconverted to anti-HBs positivity. Our findings support the notion that having an anti-HBs positive donor is important for adoptive immunity transfer and for preventing HBV replication. Serhan Küpeli, Hasan Özen, Duygu Uçkan, Mualla Þetin, Murat Tuncer, Ebru Aypar and Ilhan Tezcan Department of Pediatrics, Hacettepe University School of Medicine, Ankara, Turkey Key words: hepatitis B – bone marrow transplantation – adoptive immunity Correspondence: Ilhan Tezcan, MD, PhD, Professor of Pediatrics, Hacettepe University Ihsan Dogramacı Children's Hospital, Ankara 06100, Turkey Tel.: 0090 312 305 1170 Fax: 0090 312 324 1681 E-mail: fetezcan@hacettepe.edu.tr Accepted for publication 10 June 2002 Abbreviations: HBV, hepatitis B virus; BMT, bone marrow transplantation; GVHD, graft-vs.-host disease; VOD, veno- occlusive disease; HBsAg, hepatitis B surface antigen; HBsAb, hepatitis B surface antibody; HBeAg, hepatitis B e antigen; HBeAb, hepatitis B e antibody; HBcAb, hepatitis B core antibody; SCID, severe combined immunodeficiency; CML, chronic myelocytic leukemia; AML, acute myeloid leukemia; TM, thalassemia major; MDS, myelodysplastic syndrome; FAA, Fanconi aplastic anemia; ALL, acute lymphocytic leukemia; OP, osteopetrosis; MLD, meta- chromatic leukodystrophy; SAA, severe aplastic anemia; GD, Griscelli’s disease; FHS, familial hemophagocytic syndrome; ALD, adrenoleukodystrophy; NHL, non- Hodgkin’s lymphoma; CEP, congenital erythropoietic por- phyria; ALT, alanine aminotransferase; AST, aspartate aminotransferase; GGT, gamma glutamyl transpeptidase; ALP, alkaline phosphatase; LDH, lactate dehydrogenase. Pediatr Transplantation 2002: 6: 406–410 Printed in UK. All rights reserved Copyright Ó 2002 Blackwell Munksgaard Pediatric Transplantation ISSN 1397-3142 406