Immunogenicity of two accelerated hepatitis B vaccination protocols in liver transplant candidates.
OBJECTIVE
It is common practice to immunize patients against hepatitis B virus infection prior to orthotopic liver transplantation (OLT). We compared the seroprotection rates of two accelerated schedules with a recombinant hepatitis B vaccine in patients awaiting OLT.


METHODS
Patients were prospectively recruited and vaccinated with either 20 micrograms (group 1, n = 14) or 40 micrograms (group 2, n = 20) hepatitis B surface antigen per dosage. Thirty-nine healthy volunteers served as a historical control group. Patients in all groups were vaccinated with an accelerated schedule (0, 7 and 21 days). All patients underwent clinical and laboratory examinations (HBs antibodies, CD4/CD8 ratio, transaminases).


RESULTS
The accelerated hepatitis B vaccination schedules were well tolerated. Eight weeks after the third injection, no significant differences in seroprotection rates were observed between group 1 (31%) and group 2 (26%). There was no correlation with respect to seroconversion rates and gender, smoking habits or CD4/CD8 ratio.


CONCLUSIONS
These data suggest that accelerated vaccination schedules with a recombinant hepatitis B vaccine are safe and well-tolerated, but only achieve poor seroconversion rates in OLT candidates. Increasing the vaccine dose to 40 micrograms hepatitis B surface antigen per injection did not result in a higher response rate. Because of the low risk of acquiring de novo hepatitis B infection after transplantation, it should be questioned whether routine hepatitis B vaccination with standard recombinant vaccines prior to liver transplantation should be recommended any longer.
Engler
S H
SH
Department of Medicine, Division of Gastroenterology, University of Heidelberg, Bergheimerstrasse 58, 69115 Heidelberg, Germany.
Sauer
P W
PW
Golling
M
M
Klar
E A
EA
Benz
C
C
Stremmel
W
W
Kallinowski
B
B
D000328:Adult; D005260:Female; D006509:Hepatitis B / Q000209:etiology / Q000517:prevention & control; D017325:Hepatitis B Vaccines / Q000008:administration & dosage* / Q000276:immunology; D006801:Humans; D007115:Immunization Schedule; D016031:Liver Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D014614:Vaccines, Synthetic
D017325:Hepatitis B Vaccines; D014614:Vaccines, Synthetic