Double-dose double-phase use of second generation hepatitis B virus vaccine in patients after living donor liver transplantation: Not an effective measure in transplant recipients

  1. Noriyo Yamashiki1,3,
  2. Yasuhiko Sugawara1,2,*,
  3. Sumihito Tamura2,
  4. Junichi Kaneko2,
  5. Yuichi Matsui2,
  6. Junichi Togashi2,
  7. Norihiro Kokudo1,2,
  8. Masao Omata3,
  9. Masatoshi Makuuchi1,2,4

Article first published online: 28 AUG 2008

DOI: 10.1111/j.1872-034X.2008.00412.x

Issue

Hepatology Research

Hepatology Research

Volume 39, Issue 1, pages 7–13, January 2009

Additional Information

How to Cite

Yamashiki, N., Sugawara, Y., Tamura, S., Kaneko, J., Matsui, Y., Togashi, J., Kokudo, N., Omata, M. and Makuuchi, M. (2009), Double-dose double-phase use of second generation hepatitis B virus vaccine in patients after living donor liver transplantation: Not an effective measure in transplant recipients. Hepatology Research, 39: 7–13. doi: 10.1111/j.1872-034X.2008.00412.x

Author Information

  1. 1

    Organ Transplantation Service,

  2. 2

    The Artificial Organ and Transplantation Division, Department of Surgery,

  3. 3

    Department of Gastroenterology, University of Tokyo, Graduate School of Medicine, and

  4. 4

    Department of Surgery, Red Cross Medical Center, Tokyo, Japan

*Dr Yasuhiko Sugawara, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. Email: yasusuga-tky@umin.ac.jp

Publication History

  1. Issue published online: 26 DEC 2008
  2. Article first published online: 28 AUG 2008
  3. Received 29 March 2008; revision 7 July 2008; accepted 8 July 2008.

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Keywords:

  • Hepatitis B vaccine;
  • HBcAb positive donor;
  • HBIG;
  • lamivudine;
  • liver transplantation;
  • prophylaxis

Aims:  Post-transplant active immunization for chronic hepatitis B patients has been attempted in several studies with controversial results. We assessed the effect of a double-dose double-phase vaccination regimen among partial living donor liver recipients.

Methods:  Eighteen patients who underwent liver transplantation (LT) for chronic hepatitis B and two non-hepatitis B virus (HBV)-infected patients who received hepatitis B core antibody (HBcAb)-positive donor organs were recruited 18–78 months after LT. All were on hepatitis B immunoglobulin (HBIG) mono-prophylaxis before and throughout vaccination, to maintain hepatitis B surface antibody (HBsAb) titers of more than 100 IU/mL. Recombinant hepatitis B surface antigen vaccine (40 µg) was administered intramuscularly during weeks 0, 4, 8, 24, 28 and 32.

Results:  The patients consisted of 15 males and five females with a median age of 52 (39–59) years. None developed a sufficient HBsAb titer above 500 IU/mL by week 48. In two patients whose maximum HBsAb titer increased to above 300 IU/mL, we attempted to skip HBIG, but shortly thereafter the titer dropped below 100 IU/mL and HBIG administration was resumed. Although the HBIG dose was reduced during and after vaccination, cessation of administration was not achieved.

Conclusion:  Double-dose double-phase use of second generation recombinant vaccine was not effective in this study population. The selected population should be targeted for a conventional vaccine regimen, and different approaches, such as strong adjuvant or pre-S containing protein, should be further tested in a larger number of patients after LT for chronic hepatitis B.

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