Vaccination against hepatitis B in patients with chronic liver disease awaiting liver transplantation.
BACKGROUND
Most transplant centers in the United States immunize patients awaiting liver transplantation against hepatitis B to prevent acquisition of hepatitis B through transplantation (de novo hepatitis B). A recent study showed that only 16% of patients with cirrhosis awaiting liver transplantation responded to single-dose recombinant vaccine.


METHODS
We studied the immunogenicity of double-dose recombinant vaccine in patients with cirrhosis awaiting liver transplantation.


RESULTS
Over a 4-year period (January 1994 to December 1997), 140 patients with cirrhosis without past or current hepatitis B infection were given double-dose recombinant vaccine (40 microg of Engerix B; SmithKline Beecham, Philadelphia, PA) at 0, 1 to 2, and 2 to 4 months. Hepatitis B surface antibody (HBsAb) was measured 1 to 3 months after completing vaccination. The response rate was 37%. However, HBsAb titers became undetectable in 35% of the responders during the post-transplant follow-up period. One hundred and thirty-seven patients underwent 144 liver transplantation procedures during the study period, and 3 patients developed de novo hepatitis B (2.2%). Livers transplanted from hepatitis B core antibody (HBcAb)-positive donors was the source of de novo hepatitis B in all cases. Two of the 3 patients who developed de novo hepatitis B were immunized before transplantation and one of them was a responder.


CONCLUSIONS
Although the response rate to double-dose recombinant vaccines is higher than the previously reported response to single-dose vaccine, it still is less than optimal.
Horlander
J C
JC
Department of Medicine, Indiana University School of Medicine, Indianapolis 46202, USA.
Boyle
N
N
Manam
R
R
Schenk
M
M
Herring
S
S
Kwo
P Y
PY
Lumeng
L
L
Chalasani
N
N
D000328:Adult; D005260:Female; D006509:Hepatitis B / Q000276:immunology / Q000517:prevention & control*; D006510:Hepatitis B Antibodies / Q000097:blood*; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000008:administration & dosage; D012189:Retrospective Studies; D016896:Treatment Outcome; D014850:Waiting Lists
D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines; D011994:Recombinant Proteins