Vaccination Against Hepatitis B Virus in Cirrhotic Patients on Liver Transplant Waiting List

Abstract

Patients with cirrhosis may fail to respond to anti–hepatitis B vaccine. An adequate response would be especially interesting when patients are on a liver transplant waiting list. Posttransplantation de novo hepatitis B has been well documented. One possible source is the grafting of organs from hepatitis B surface antigen (HBsAg)–negative, antibody to HBsAg (anti‐HBs)–positive, antibody to hepatitis B core antigen–positive donors. The achievement of high titers of anti‐HBs could be protective in this setting. We studied prospectively the response rate to recombinant hepatitis B vaccine (3 40‐μg doses administered at 0, 1, and 2 months) in 62 patients with end‐stage liver disease awaiting liver transplantation. Twenty‐two patients showed antibody response (44%). A further 3 doses were administered in 15 of 28 nonresponders and were effective in 9 patients. Thus, the response rate reached 62% (31 of 50 patients completing 1 or 2 vaccination schedules before liver transplantation). Classic hepatitis B vaccination studies of patients with cirrhosis yield lower response rates. Vaccination with this double‐dose schedule should be considered in such patients before liver transplantation.