title: Immunogenicity of two accelerated hepatitis B vaccination protocols in liver transplant candidates.
abstract: 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.
authors.affiliation: Department of Medicine, Division of Gastroenterology, University of Heidelberg, Bergheimerstrasse 58, 69115 Heidelberg, Germany.
authors.forename: S H
authors.initials: SH
authors.lastname: Engler
authors.forename: P W
authors.initials: PW
authors.lastname: Sauer
authors.forename: M
authors.initials: M
authors.lastname: Golling
authors.forename: E A
authors.initials: EA
authors.lastname: Klar
authors.forename: C
authors.initials: C
authors.lastname: Benz
authors.forename: W
authors.initials: W
authors.lastname: Stremmel
authors.forename: B
authors.initials: B
authors.lastname: Kallinowski
mesh_terms: 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
chemical_list: D017325:Hepatitis B Vaccines; D014614:Vaccines, Synthetic