title: Response to a vaccination schedule with 4 doses of 40 microg against hepatitis B virus in cirrhotic patients evaluated for liver transplantation.
abstract: We conducted a retrospective study to evaluate the response to recombinant hepatitis B vaccine after 4 intramuscular doses (40 microg) administered at 0, 1, 2, and 6 months in 157 cirrhotic patients who were liver transplant candidates. Seventeen nonresponders were revaccinated with the same schedule. We studied the association between the following variables and the vaccine response: age, gender, etiology of cirrhosis, diabetes, severity of liver disease (Child-Pugh class and Model for End-Stage Liver Disease [MELD] score), and the number of administered doses. The response rates were: 1 dose, 40% (2/5); 2 doses, 0% (0/7); 3 doses, 32.7% (16/49); and 4 doses, 31.3% (30/96) of patients. The median hepatitis B surface antibody (anti-HBs) titer was 45 mU/mL (range, 11-620 mU/mL). The response rate to revaccination was 41.2% (median anti-HBs titer, 88 mU/mL; range, 18-190 mU/mL). Diabetics showed a lower response rate than nondiabetic patients (17.2% vs 35.3%; P = .046). No association was observed between the response rate to vaccine and the other variables. In conclusion, the response rate to hepatitis B vaccine reached a little more than 30% in cirrhotic patients who received 3 or 4 doses. No higher response rate was observed among patients who received 4 doses. Diabetes was associated with a lower response rate. Anti-HBs seroconversion rates were not associated with the other variables. Revaccination may significantly increase the response rate to hepatitis B vaccine in cirrhotic patients, and may be considered in nonresponders after the third dose. Early vaccination against HBV should be considered in such patients.
authors.affiliation: Department of Digestive Diseases, Virgen del Rocío University Hospital, Seville, Spain. jpascasio@ya.com
authors.forename: J M
authors.initials: JM
authors.lastname: Pascasio
authors.forename: S
authors.initials: S
authors.lastname: Aoufi
authors.forename: A
authors.initials: A
authors.lastname: Gash
authors.forename: J M
authors.initials: JM
authors.lastname: Sousa
authors.forename: R
authors.initials: R
authors.lastname: Perea
authors.forename: M
authors.initials: M
authors.lastname: Sayago
authors.forename: M T
authors.initials: MT
authors.lastname: Ferrer
authors.forename: R
authors.initials: R
authors.lastname: Valencia
authors.forename: M A
authors.initials: MA
authors.lastname: Gómez-Bravo
authors.forename: A
authors.initials: A
authors.lastname: Bernardos
authors.forename: J L
authors.initials: JL
authors.lastname: Márquez
mesh_terms: D048909:Diabetes Complications / Q000276:immunology / Q000821:virology; D004305:Dose-Response Relationship, Drug; D005260:Female; D006509:Hepatitis B / Q000276:immunology*; D006510:Hepatitis B Antibodies / Q000097:blood; D017325:Hepatitis B Vaccines / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007115:Immunization Schedule; D008103:Liver Cirrhosis / Q000276:immunology / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000276:immunology*; D008297:Male; D012189:Retrospective Studies
chemical_list: D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines