Double-dose hepatitis B vaccination in cirrhotic patients on a liver transplant waiting list

Abstract

Development of immunity to hepatitis B virus in cirrhotic patients waiting for liver transplantation is highly desirable. Though a double-dose regimen is available, little is know about its effectiveness. We examined the efficacy of double-dose hepatitis B virus vaccination in cirrhotic patients waiting for liver transplantation. We studied 43 patients who were waiting for liver transplantation. They were vaccinated with three doses of 40 µ µ µ µ µg hepatitis B vaccine at 0, 1 and 6 months; the normal dose is 20 µ µ µ µ µg. Efficacy was measured based on seroconversion of anti-HBs. Global response to the primary vaccination scheme was 67.5% (29 patients). Forty-one per cent of responders had anti-HBs titers above 1,000 IU/mL. No factors were associated with response, based on multivariate analysis. The vaccination scheme of 40 µ µ µ µ µg at 0, 1 and 6 months was superior to conventional vaccination doses (20 µ µ µ µ µg) for cirrhotic patients on a waiting list for liver transplantation.

Response to hepatitis B vaccination in patients with liver cirrhosis

“…HBV infection in cirrhotic patients may have serious consequences as the clinical phenotype of the disease is much more severe because of the impaired functional capacity of the liver compared to the acute HBV infection in healthy individuals. However, several studies have shown that the immunogenicity following HBV vaccination in patients with liver cirrhosis seem to be ineffective . It has been shown that administration of additional vaccine doses after a primary vaccination series in subjects who do not respond to the vaccination is not associated with the development of adverse events …”

“…A double dose (40 μg) of HBV vaccine or the use of subcutaneous injection or the administration of additional vaccine doses has been used in HIV‐infected patients, hemodialysis patients, or immunocompromised patients and mainly resulted in better immune responses . Trials that included patients with liver cirrhosis adopted the double‐dose regimen or accelerated dose schedule and compared to the normal schedule giving relatively higher seroprotection rates …”

“…The seroconversion rates and antibody titers among these patients have been shown to be much lower compared to healthy individuals . Many attempts have been performed to improve the immunogenicity of the HBV vaccination by increasing the standard dose of the vaccine or accelerating the dose schedule …”

Granulocyte Colony Stimulating Factor Adjuvant Role on the Immunological Response to Hepatitis B Vaccine in Patients With Cirrhosis: A Double Blind Randomized Placebo Controlled Trial

“…Therefore, in some other studies double dose HBV vaccines were used to increase the potency of immunologic responses (11, 12). A prospective study by Horlander et al showed that HBV vaccine dose duplication could result in better antibody responses, compared to single dose vaccination, but the final response was still very low (7).…”

Sex bias in response to hepatitis B vaccination in end-stage renal disease patients: Meta-analysis

“…Very limited data coming from the previous clinical trials proposes that gender is a major interfering factor in the context of HB vaccine immunogenicity [9] . On the other hand, most of the existing clinical trials represent no significant role for gender on response to HB vaccination, either in kidney disease patients [7,10] or other end-stage organ disease patients [39] . However, the patient population in each of the clinical trials was limited, and in case there is a delicate difference in seroresponse to HB vaccine between the two genders, it can be easily lost.…”