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 microg) of recombinant vaccine at month 0, 1, and 2, respectively. This was followed, in nonresponders, by a second cycle of 6 intradermal 10 microg 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.

Angelico, M., DI PAOLO, D., Trinito, M., Petrolati, A., Araco, A., Zazza, S., et al. (2002). Failure of a reinforced triple course of hepatitis B vaccination in patients transplanted for HBV-related cirrhosis. HEPATOLOGY, 35(1), 176-181 [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;TISONE, GIUSEPPE
2002-01-01

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 microg) of recombinant vaccine at month 0, 1, and 2, respectively. This was followed, in nonresponders, by a second cycle of 6 intradermal 10 microg 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.
gen-2002
Pubblicato
Rilevanza internazionale
Articolo
Sì, ma tipo non specificato
Settore MED/12 - GASTROENTEROLOGIA
English
Con Impact Factor ISI
Hepatitis B Surface Antigens; Treatment Failure; Hepatitis B virus; Humans; Lamivudine; Hepatitis B Vaccines; Vaccines, Synthetic; Liver Cirrhosis; Hepatitis B e Antigens; Liver Transplantation; Polymerase Chain Reaction; DNA, Viral; Hepatitis B Antibodies; Adult; Hepatitis B; Middle Aged; Male; Female; Immunoglobulins
Angelico, M., DI PAOLO, D., Trinito, M., Petrolati, A., Araco, A., Zazza, S., et al. (2002). Failure of a reinforced triple course of hepatitis B vaccination in patients transplanted for HBV-related cirrhosis. HEPATOLOGY, 35(1), 176-181 [10.1053/jhep.2002.30278].
Angelico, M; DI PAOLO, D; Trinito, M; Petrolati, A; Araco, A; Zazza, S; Lionetti, R; Casciani, C; Tisone, G
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2108/66847
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