1. Failure of a reinforced triple course of hepatitis B vaccination in patients transplanted for HBV-related cirrhosis
- Author
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A. Petrolati, Antonio Araco, S Zazza, Raffaella Lionetti, M.O. Trinito, Mario Angelico, Daniele Di Paolo, Giuseppe Tisone, and Carlo Umberto Casciani
- Subjects
medicine.medical_specialty ,HBsAg ,Cirrhosis ,Hepatology ,business.industry ,medicine.medical_treatment ,virus diseases ,Lamivudine ,Hepatitis B ,Liver transplantation ,medicine.disease ,Gastroenterology ,digestive system diseases ,Surgery ,Transplantation ,Vaccination ,Titer ,Internal medicine ,Medicine ,business ,medicine.drug - Abstract
Long-term immunoprophylaxis with anti-HBs immunoglobulins (HBIg) is used to prevent hepatitis B (HBV) reinfection after liver transplantation for HBV-related cirrhosis. This approach is highly expensive. A recent report proposed posttransplant HBV vaccination with a reinforced schedule as an alternative strategy to allow HBIg discontinuation. We investigated the efficacy of a reinforced triple course of HBV vaccination in 17 patients transplanted for HBsAg-positive cirrhosis 2 to 7 years earlier. The first cycle consisted of 3 double intramuscular doses (40 microg) of recombinant vaccine at month 0, 1, and 2, respectively. This was followed, in nonresponders, by a second cycle of 6 intradermal 10 microg doses every 15 days. All nonresponders then received a third cycle identical to the first one. Vaccination started 4.5 months after HBIg discontinuation, and lamivudine (100 mg/day) was given throughout the study. All patients were seronegative for HBsAg and HBV-DNA (by PCR) and positive for anti-HBe, and 7 were positive for anti-HDV. After the first cycle one patient (#5, 53 years old, male) developed an anti-HBs titer of 154 IU/L, another (#12) reached a titer of 20 IU/L and the remainder had titers more...
- Published
- 2002
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