Hepatitis B virus immunization with an adjuvant containing vaccine after liver

liver411

Transplant International
Volume 19 Page 828  - October 2006
doi:10.1111/j.1432-2277.2006.00374.x
Volume 19 Issue 10


ORIGINAL ARTICLE
Hepatitis B virus immunization with an adjuvant containing vaccine after
liver transplantation for hepatitis B-related disease: failure of humoral
and cellular immune response

Jens Rosenau1, Nazanin Hooman1, Kinan Rifai1, Therese Solga1, Hans L.
Tillmann2, Edith Grzegowski3, Björn Nashan4, Juergen Klempnauer5, Christian
P. Strassburg1, Heiner Wedemeyer1 and Michael P. Manns1
Summary

Long-term hepatitis B reinfection prophylaxis after liver transplantation
with hepatitis B immunoglobulin (HBIG) and nucleoside analogues is expensive
and inconvenient. Studies evaluating humoral immune responses to hepatitis B
virus (HBV) vaccines showed conflicting results. Best results were achieved
under continuous HBIG administration with an adjuvant–containing HBsAg
vaccine. In the present study, 8 patients who had been HBsAg positive and
HBV DNA negative prior to liver transplantation were immunized with
HBsAg-vaccine containing the adjuvant 3-deacylated monophosphoryl-lipid-A.
Vaccination was started after discontinuation of HBIG. Six vaccinations were
administered at weeks 0, 2, 4, 12, 16 and 24. Humoral (anti-HBs titres) and
cellular (enzyme-linked immunospot assay and fluorescence-activated cell
sorting analysis) immune responses were studied. Only one of eight patients
responded with a humoral immune response (maximum anti-HBs titre 561 U/l).
In this patient, decrease of anti-HBs titre before vaccination was
significantly slower than in the other seven patients and anti-HBs did not
become negative before first vaccination. A T-cell response to HBsAg could
not be detected in any of the patients. The responder was the only patient
who showed a T-cell response to HBcAg. In conclusion, the
adjuvant-containing vaccine did not induce a humoral or a detectable
cellular immune response in most patients. Patient-related preconditions and
concomitant HBIG administration should be further investigated as possible
predictors for response.