title: Double-dose double-phase use of second generation hepatitis B virus vaccine in patients after living donor liver transplantation: Not an effective measure in transplant recipients.
abstract: OBJECTIVE
  Post-transplant active immunization for chronic hepatitis B patients has been attempted in several studies with controversial results. We assessed the effect of a double-dose double-phase vaccination regimen among partial living donor liver recipients.
  
  
  METHODS
  Eighteen patients who underwent liver transplantation (LT) for chronic hepatitis B and two non-hepatitis B virus (HBV)-infected patients who received hepatitis B core antibody (HBcAb)-positive donor organs were recruited 18-78 months after LT. All were on hepatitis B immunoglobulin (HBIG) mono-prophylaxis before and throughout vaccination, to maintain hepatitis B surface antibody (HBsAb) titers of more than 100 IU/mL. Recombinant hepatitis B surface antigen vaccine (40 microg) was administered intramuscularly during weeks 0, 4, 8, 24, 28 and 32.
  
  
  RESULTS
  The patients consisted of 15 males and five females with a median age of 52 (39-59) years. None developed a sufficient HBsAb titer above 500 IU/mL by week 48. In two patients whose maximum HBsAb titer increased to above 300 IU/mL, we attempted to skip HBIG, but shortly thereafter the titer dropped below 100 IU/mL and HBIG administration was resumed. Although the HBIG dose was reduced during and after vaccination, cessation of administration was not achieved.
  
  
  CONCLUSIONS
  Double-dose double-phase use of second generation recombinant vaccine was not effective in this study population. The selected population should be targeted for a conventional vaccine regimen, and different approaches, such as strong adjuvant or pre-S containing protein, should be further tested in a larger number of patients after LT for chronic hepatitis B.
authors.affiliation: Organ Transplantation Service, University of Tokyo, Tokyo, Japan.
authors.forename: Noriyo
authors.initials: N
authors.lastname: Yamashiki
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sugawara
authors.forename: Sumihito
authors.initials: S
authors.lastname: Tamura
authors.forename: Junichi
authors.initials: J
authors.lastname: Kaneko
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Matsui
authors.forename: Junichi
authors.initials: J
authors.lastname: Togashi
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
authors.forename: Masao
authors.initials: M
authors.lastname: Omata
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Makuuchi