title: Failure of hepatitis B vaccination in patients receiving lamivudine prophylaxis after liver transplantation for chronic hepatitis B.
abstract: OBJECTIVE
  Lamivudine prophylaxis against hepatitis B virus (HBV) reinfection after liver transplantation is associated with recurrence due to escape mutants.
  
  
  METHODS
  Fifty-two patients on lamivudine prophylaxis at a median of 412 days (median, 370-2040 days) after transplantation for chronic HBV-related liver disease received two courses of an accelerated schedule of double-dose recombinant HBV vaccine. Before vaccination, all patients were seronegative for HBsAg, anti-HBs and HBV DNA (by qPCR). Three intramuscular doses of vaccine (40 microg each) were administered monthly and another identical course was repeated after 3 months. Lamivudine (100mg/day) was continued throughout the study.
  
  
  RESULTS
  After the first course, two patients developed a weak response (anti-HBs titre of 12 mIU/mL) that disappeared rapidly. One early responder developed anti-HBs (27 mIU/mL) again after the second course but the other did not. Two other patients developed response (anti-HBs titre of 17 and 103 mIU/mL, respectively) giving an overall response rate of 7.7%. The antibody level declined rapidly. At the end of the study, one patient who did not respond had developed viral breakthrough which was treated with adefovir dipivoxil therapy.
  
  
  CONCLUSIONS
  Active immunization with two courses of double-dose recombinant HBV vaccine has limited efficacy in patients receiving lamividine prophylaxis after liver transplantation.
authors.affiliation: Centre for the Study of Liver Disease, Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong, China. chungmlo@hkucc.hku.hk
authors.forename: Chung Mau
authors.initials: CM
authors.lastname: Lo
authors.forename: Chi Leung
authors.initials: CL
authors.lastname: Liu
authors.forename: See Ching
authors.initials: SC
authors.lastname: Chan
authors.forename: George K
authors.initials: GK
authors.lastname: Lau
authors.forename: Sheung Tat
authors.initials: ST
authors.lastname: Fan
mesh_terms: D000293:Adolescent; D000328:Adult; D004279:DNA, Viral / Q000097:blood; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006514:Hepatitis B Surface Antigens / Q000097:blood; D017325:Hepatitis B Vaccines / Q000008:administration & dosage / Q000627:therapeutic use*; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000517:prevention & control* / Q000601:surgery / Q000821:virology; D006801:Humans; D007124:Immunoenzyme Techniques; D007273:Injections, Intramuscular; D019259:Lamivudine / Q000627:therapeutic use*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D055502:Secondary Prevention; D017211:Treatment Failure; D014611:Vaccination
chemical_list: D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine