Extended HBV vaccination in liver transplant recipients for HBV-related cirrhosis: report of two successful cases.
The effectiveness of hepatitis B virus vaccination in liver transplant recipients for hepatitis B virus-related end-stage liver disease is controversial. We report two successful cases, who developed sustained protection after long-term vaccination. Case 1. A 58-year-old male, transplanted 9 years earlier, received three intramuscular monthly doses of 40 microg of recombinant S vaccine and developed an anti-hepatitis B surface titre of 154 IU/L. After an additional 40 microg dose, he reached an anti-hepatitis B surface peak of 687 IU/L and then maintained a "protective" titre (>100 IU/L) without further vaccinations for the next 40 months. At this time, revaccination with three monthly doses of 40 microg resulted in an anti-hepatitis B surface titre greater than 25,000 IU/L, sustained over time. Case 2. A 56-year-old woman, transplanted 8 years earlier, first received three intramuscular monthly doses of 40 microg of S vaccine without developing any detectable anti-HBs. She was then given multiple intradermal vaccine doses which resulted in a titre of 37 IU/L. Next, after readministration of three 40 microg intramuscular monthly doses, she developed an anti-HBs titre of 280 IU/L. In the following 4 years, the anti-HBs titre dropped below 100 IU/L four times (at month 20, 30, 38 and 44) and readministration of single 40 microg doses of vaccine was always sufficient to restore a protective titre. Conclusion. Extended HBV vaccination may afford valid protection against HBV recurrence in selected liver transplant recipients.
Di Paolo
D
D
Gastroenterology Unit, Department of Public Health, University of Rome Tor Vergata Medical School, Via Montpellier 1, 00133 Rome, Italy.
Lenci
I
I
Trinito
M O
MO
Tisone
G
G
Angelico
M
M
D005260:Female; D006509:Hepatitis B / Q000097:blood / Q000150:complications* / Q000628:therapy*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D017325:Hepatitis B Vaccines / Q000008:administration & dosage / Q000627:therapeutic use*; D006515:Hepatitis B virus / Q000187:drug effects* / Q000276:immunology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery; D008103:Liver Cirrhosis / Q000097:blood / Q000628:therapy* / Q000821:virology*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D014614:Vaccines, Synthetic / Q000627:therapeutic use
D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines; D014614:Vaccines, Synthetic