The researchers investigated the efficacy of a reinforced triple course of HBV vaccination in patients transplanted for HbsAg-positive cirrhosis.
They reported their findings in the January issue of Hepatology.
Long-term immunoprophylaxis with anti-HBs immunoglobulins (HBIg) is used to prevent hepatitis B virus (HBV) reinfection after liver transplantation for HBV-related cirrhosis. This approach is highly expensive.
A recent report proposed post-transplant HBV vaccination with a reinforced schedule as an alternative strategy to allow HBIg discontinuation.
A total of 17 patients, transplanted 2 to 7 years earlier, were included in the trial.
The first cycle of vaccination consisted of 3 double intramuscular doses (40 µg) of recombinant vaccine at month 0, 1, and 2, respectively.
This was followed, in non-responders, by a second cycle of 6 intradermal 10 µg doses every 15 days.
All non-responders then received a third cycle identical to the first one.
Vaccination started 4.5 months after HBIg discontinuation, and lamivudine (100 mg/day) was given throughout the study.
| Very few patients responded to reinforced HBV vaccination.
| Hepatology |
All patients were seronegative for HBsAg and HBV-DNA, and positive for anti-Hbe. Seven individuals were positive for anti-HDV.
After the first cycle, one patient (53 years old, male) developed an anti-HBs titer of 154 IU/L. At month 7, this patient reached a titer of 687 IU/L.
Another subject reached a titer of 20 IU/L after the first cycle, and the remainder had titers less than 10 IU/L.
Following the second cycle only one additional patient had a slight response (an anti-HBs titer of 37 IU/L). After the third cycle the response in this patient rose to an anti-HBs titer of 280 IU/L.
The titer dropped to 10 IU/L in another patient after the third cycle.
Mario Angelico, of the Department of Public Health at the University of Rome Tor Vergata, concluded on behalf of fellow colleagues, "A highly reinforced HBV vaccination program is effective only in a few patients who had liver transplants for HBV-related cirrhosis."