Hepatitis B virus immunization with an adjuvant containing vaccine after liver t

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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 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.

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