Serologic response to hepatitis B vaccination among lung transplantation candidates.
BACKGROUND
Optimal hepatitis B (HBV) vaccination strategies for lung transplantation (LT) candidates are not well established.


METHODS
LT candidates with negative anti-HBs and anti-HBc antibody titers at baseline who received standard-dose HBV vaccination (Recombivax-HB 10 mcg/mL or Engerix-B 20 mcg/mL) administered at months 0, 1, and 6 or an accelerated vaccination schedule on days 0, 7 to 14, and 21 to 28 between June 1988 and October 2012 were studied. Patients who were more likely to undergo LT within 6 months of evaluation received the accelerated vaccination schedule starting in August 2009.


RESULTS
Ninety-six HBV-seronegative patients who completed the vaccination series and had postvaccination anti-HBs titers available were identified. Median age was 60 years; 55.2% were female, and 92.7% were white. Underlying lung diseases included COPD (44.8%), idiopathic pulmonary fibrosis (22.9%), interstitial lung disease (15.6%), and cystic fibrosis (8.3%). The overall anti-HBs response rate was 54.2%. There was no significant difference in vaccine responses between accelerated and standard vaccination schedules (54.2% vs. 54.1%; P=1.0). Patients who received steroids or other immunosuppressants before transplantation had lower response rates compared with those who did not (38.9% vs. 63.3%; P=0.03).


CONCLUSIONS
Better vaccination strategies to improve response rate are needed in this population. The accelerated HBV vaccination schedule elicited similar anti-HBs responses as the standard schedule and could be advantageous in this population, given current organ allocation practices, and it could allow repeat vaccination series for initial nonresponders before transplantation.
1 Division of Infectious Diseases, 2 Department of Pharmacy, 3 Division of Pulmonary Medicine and Critical Care, Brigham & Women's Hospital, 4 Harvard Medical School, Boston, MA. 5 Address correspondence to: Alicia Galar Pharm.D., Ph.D., Division of Infectious Diseases, Brigham and Women's Hospital, 75 Francis St., PBB-A4, Boston, MA 02115.
Alicia
A
Galar
Brian A
BA
Engelson
David W
DW
Kubiak
Jose H
JH
Licona
Steve
S
Boukedes
Hilary J
HJ
Goldberg
Lindsey R
LR
Baden
Francisco M
FM
Marty
Nicolas C
NC
Issa
D000368:Aged; D003550:Cystic Fibrosis / Q000150:complications / Q000601:surgery; D005260:Female; D006509:Hepatitis B / Q000517:prevention & control*; D006510:Hepatitis B Antibodies / Q000097:blood*; D017325:Hepatitis B Vaccines / Q000627:therapeutic use*; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000150:complications / Q000601:surgery; D007115:Immunization Schedule; D008107:Liver Diseases / Q000821:virology; D017563:Lung Diseases, Interstitial / Q000150:complications / Q000601:surgery; D016040:Lung Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000601:surgery; D012189:Retrospective Studies; D013997:Time Factors
D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines