Response to Vaccination Against Hepatitis B Virus with a Schedule of Four 40-μg Doses in Cirrhotic Patients Evaluated for Liver Transplantation: Factors Associated with a Response

Response to hepatitis B vaccination in patients with liver cirrhosis

“…The type of the vaccine was recombinant hepatitis B vaccine: Engerix‐B (SmithKline Beecham, Philadelphia, Pennsylvania), Recombivax HB (Pasteuer Merieux/MD, Lyon, France), and Shanvac‐B (M/S Shantha Biotech, India) . The doses of the vaccine ranged from 20 μg to 40 μg . The route of vaccine administration was intramuscular in 10 studies .…”

“…The search yielded 473 studies, and the 462 deemed as not relevant with the subject of this review because they were mainly referred to immunogenicity of hepatitis B vaccination in patients with liver disease in general, which is beyond the purpose of this study. Eleven studies met the inclusion criteria and included in this review …”

“…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 …”