Failure of a reinforced triple course of hepatitis B vaccination in patients transplanted for HBV-related cirrhosis

Mario Angelico, Daniele Di Paolo, Massimo O. Trinito, Alessandra Petrolati, Antonio Araco, Settimio Zazza, Raffaella Lionetti, Carlo U. Casciani, Giuseppe Tisone

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Abstract

Long-term immunoprophylaxis with anti-HBs immunoglobulins (HBIg) is used to prevent hepatitis B (HBV) reinfection after liver transplantation for HBV-related cirrhosis. This approach is highly expensive. A recent report proposed posttransplant HBV vaccination with a reinforced schedule as an alternative strategy to allow HBIg discontinuation. We investigated the efficacy of a reinforced triple course of HBV vaccination in 17 patients transplanted for HBsAg - positive cirrhosis 2 to 7 years earlier. The first cycle consisted of 3 double intramuscular doses (40 μg) of recombinant vaccine at month 0, 1, and 2, respectively. This was followed, in nonresponders, by a second cycle of 6 intradermal 10 μg doses every 15 days. All nonresponders 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. All patients were seronegative for HBsAg and HBV-DNA (by PCR) and positive for anti-HBe, and 7 were positive for anti-HDV. After the first cycle one patient (#5, 53 years old, male) developed an anti-HBs titer of 154 IU/L, another (#12) reached a titer of 20 IU/L and the remainder had titers <10 IU/L. At month 7, patient #5 reached a titer of 687 IU/L. After the second cycle only one additional patient (#9) had a slight response (an anti-HBs titer of 37 IU/L). After the third cycle patient #9 rose to an anti-HBs titer of 280 IU/L, patient #12 dropped to 10 IU/L, and no other patient responded. In conclusion, a highly reinforced HBV vaccination program is effective only in a few patients who had liver transplants for HBV - related cirrhosis.

Original languageEnglish
Pages (from-to)176-181
Number of pages6
JournalHepatology
Volume35
Issue number1
DOIs
Publication statusPublished - 2002

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Hepatitis B
Vaccination
Fibrosis
Immunoglobulins
Hepatitis B Surface Antigens
Synthetic Vaccines
Lamivudine
Liver Transplantation
Appointments and Schedules
Transplants
Polymerase Chain Reaction
Liver
DNA

ASJC Scopus subject areas

  • Hepatology

Cite this

Angelico, M., Di Paolo, D., Trinito, M. O., Petrolati, A., Araco, A., Zazza, S., ... Tisone, G. (2002). Failure of a reinforced triple course of hepatitis B vaccination in patients transplanted for HBV-related cirrhosis. Hepatology, 35(1), 176-181. https://doi.org/10.1053/jhep.2002.30278

Failure of a reinforced triple course of hepatitis B vaccination in patients transplanted for HBV-related cirrhosis. / Angelico, Mario; Di Paolo, Daniele; Trinito, Massimo O.; Petrolati, Alessandra; Araco, Antonio; Zazza, Settimio; Lionetti, Raffaella; Casciani, Carlo U.; Tisone, Giuseppe.

In: Hepatology, Vol. 35, No. 1, 2002, p. 176-181.

Research output: Contribution to journalArticle

Angelico, M, Di Paolo, D, Trinito, MO, Petrolati, A, Araco, A, Zazza, S, Lionetti, R, Casciani, CU & Tisone, G 2002, 'Failure of a reinforced triple course of hepatitis B vaccination in patients transplanted for HBV-related cirrhosis', Hepatology, vol. 35, no. 1, pp. 176-181. https://doi.org/10.1053/jhep.2002.30278
Angelico, Mario ; Di Paolo, Daniele ; Trinito, Massimo O. ; Petrolati, Alessandra ; Araco, Antonio ; Zazza, Settimio ; Lionetti, Raffaella ; Casciani, Carlo U. ; Tisone, Giuseppe. / Failure of a reinforced triple course of hepatitis B vaccination in patients transplanted for HBV-related cirrhosis. In: Hepatology. 2002 ; Vol. 35, No. 1. pp. 176-181.
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abstract = "Long-term immunoprophylaxis with anti-HBs immunoglobulins (HBIg) is used to prevent hepatitis B (HBV) reinfection after liver transplantation for HBV-related cirrhosis. This approach is highly expensive. A recent report proposed posttransplant HBV vaccination with a reinforced schedule as an alternative strategy to allow HBIg discontinuation. We investigated the efficacy of a reinforced triple course of HBV vaccination in 17 patients transplanted for HBsAg - positive cirrhosis 2 to 7 years earlier. The first cycle consisted of 3 double intramuscular doses (40 μg) of recombinant vaccine at month 0, 1, and 2, respectively. This was followed, in nonresponders, by a second cycle of 6 intradermal 10 μg doses every 15 days. All nonresponders 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. All patients were seronegative for HBsAg and HBV-DNA (by PCR) and positive for anti-HBe, and 7 were positive for anti-HDV. After the first cycle one patient (#5, 53 years old, male) developed an anti-HBs titer of 154 IU/L, another (#12) reached a titer of 20 IU/L and the remainder had titers <10 IU/L. At month 7, patient #5 reached a titer of 687 IU/L. After the second cycle only one additional patient (#9) had a slight response (an anti-HBs titer of 37 IU/L). After the third cycle patient #9 rose to an anti-HBs titer of 280 IU/L, patient #12 dropped to 10 IU/L, and no other patient responded. In conclusion, a highly reinforced HBV vaccination program is effective only in a few patients who had liver transplants for HBV - related cirrhosis.",
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