Prophylaxis of recurrent hepatitis B virus by vaccination after liver transplant: preliminary results

Arbizu, Eduardo Albéniz; Marugán, Rafael Bárcena; Nieto, Elena; Alonso, Elisa Carrera; González, Miguel; García, Javier Moreno; Lopez, E; Vázquez-Garza, Javier Nuño; Martín-Dávila, Pilar

doi:10.1016/s0041-1345(03)00633-x

Cited by 32 publications

(24 citation statements)

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“…Both factors, old age and obesity, have been reported to negatively influence the response to HBV vaccination 21. Response rates in the HBV group was lower but still reached 40% (4 of 10 patients) with anti‐HBs titers above 500 IU/L, a result that has not been achieved even with reinforced courses of vaccination with standard HBV vaccines in 3 larger series 12–14. In addition, it was possible to discontinue HBIg immunoprophylaxis in responders without recurrence of HBV in the graft by the end of 2004.…”

Section: Discussionmentioning

confidence: 99%

“…An elegant way to avoid these inconveniences would be to stimulate the patients' own immune system to produce protective antibodies against the virus for example by vaccinating them against HBV. Unfortunately, standard vaccines yield only low response rates in immunocompromised patients and protective anti‐HBs titers above 100 IU/L, the threshold below which HBIg is generally administered, are only rarely obtained in liver transplant patients 12–14. However, recent data suggest that the use of novel adjuvant systems considerably enhances immune responses to HBV vaccines in difficult‐to‐immunize populations such as liver transplant patients 15.…”

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confidence: 99%

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Response to an experimental HBV vaccine permits withdrawal of HBIg prophylaxis in fulminant and selected chronic HBV-infected liver graft recipients

Stärkel

Stoffel

Lerut³

et al. 2005

Liver Transpl

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Response to an experimental HBV vaccine permits withdrawal of HBIg prophylaxis in fulminant and selected chronic HBV-infected liver graft recipients

Stärkel

Stoffel

Lerut³

et al. 2005

Liver Transpl

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“…The continuation of HBIG treatment and the special adjuvant system in the vaccine were discussed as the most probable constitutive variables for the good response. In studies by Albeniz Arbizu et al14 and Lo et al,15 neither concomitant HBIG treatment nor special adjuvants were used, and response rates or response magnitude were significantly lower again.…”

Section: Vaccination Trials With Hbsag‐containing Vaccines After Olt mentioning

confidence: 98%

“…The present study was initiated to investigate whether continuation of HBIG treatment is a determinant factor for good response, even if a standard vaccine without special adjuvants that has been used in several previous studies after discontinuation of HBIG is administered 12, 14–16…”

Section: Vaccination Trials With Hbsag‐containing Vaccines After Olt mentioning

confidence: 99%

Failure of hepatitis B vaccination with conventional HBsAg vaccine in patients with continuous HBIG prophylaxis after liver transplantation

et al. 2007

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Hepatitis B vaccination after liver transplantation for hepatitis B-related liver disease has been investigated as an alternative strategy to reinfection prophylaxis with hepatitis B immunoglobulin (HBIG) with conflicting results. In most studies, HBIG treatment was discontinued before vaccination. An outstanding good response was achieved with vaccination under continuous HBIG administration using hepatitis B surface antigen (HBsAg)-based vaccine containing special adjuvants. Both, adjuvants and continuous HBIG administration have been discussed as crucial factors for good response. Twenty-four patients were vaccinated with conventional double dose recombinant vaccine containing 40 g HBsAg up to 12 times at weeks 0, 2, 4 (cycle 1), 12, 14, 16 (cycle 2), 24, 26, 28 (cycle 3), and 36, 38, 40 (cycle 4). All patients received 2,000 IU HBIG every 6 weeks (4 times intravenously and 4 times intramuscularly). A significant response was defined as reconfirmed increase of anti-HBsantigen (anti-HBs) unexplained by HBIG administration or lack of anti-HBs decrease below 100 IU/L after discontinuation of HBIG treatment after week 48. Only 2 of 24 patients (8.3%) responded significantly. Anti-HBs started to increase after the seventh vaccination (cycle 3, during intramuscular HBIG administration) in 1 patient and after 12th vaccination (cycle 4, during intravenous HBIG administration) in the other. Maximum anti-HBs levels were Ͼ1,000 IU/L in both patients and decreased significantly slower as compared to passive prophylaxis during follow-up. In conclusion, the conventional HBsAg vaccine failed to induce a significant humoral immune response in most patients despite continued HBIG treatment. Further studies should address the question, of whether the use of potent adjuvant systems results in higher response rates. Liver Transpl 13: 367-373, 2007. © 2007 AASLD.Received May 28, 2006; accepted August 19, 2006. Hepatitis B virus (HBV) reinfection of the liver graft after transplantation for HBV-related liver disease was associated with a considerably reduced graft and patient survival before the nucleoside analogue era.1,2 Using reinfection prophylaxis with hepatitis B immunoglobulin (HBIG) reinfection rates decreased significantly. 3,4 Reinfections occurred less frequently under long-term immunoprophylaxis as compared to short-term prophylaxis.3,4 Few reinfections were reported more than 12 months after orthotopic Abbreviations: HBV, hepatitis B virus; HBIG, hepatitis B immunoglobulin; OLT, orthotopic liver transplantation; HBsAg, hepatitis B surface antigen; anti-HBs, anti-HBs-antigen; MPL, 3-deacyled monophosphoryl lipid A.

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“…Similarly, a 75% rate of response to hepatitis B vaccination (9 out of 12 patients; anti-HBs titers . 10 IU/L) was achieved by another Spanish group [6,7]. In these studies HBIG administration was stopped in all vaccine responders without signs of HBV-infection recurrence over a mean post-vaccination follow-up of more than 40 months [4 -7].…”

mentioning

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Hepatitis B vaccination after liver transplantation as a strategy to discontinue prophylaxis with hepatitis B immune globulin

Rimola

Sánchez‐Fueyo

2004

Journal of Hepatology

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Prophylaxis of recurrent hepatitis B virus by vaccination after liver transplant: preliminary results

Cited by 32 publications

References 9 publications

Response to an experimental HBV vaccine permits withdrawal of HBIg prophylaxis in fulminant and selected chronic HBV-infected liver graft recipients

Response to an experimental HBV vaccine permits withdrawal of HBIg prophylaxis in fulminant and selected chronic HBV-infected liver graft recipients

Failure of hepatitis B vaccination with conventional HBsAg vaccine in patients with continuous HBIG prophylaxis after liver transplantation

Hepatitis B vaccination after liver transplantation as a strategy to discontinue prophylaxis with hepatitis B immune globulin

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