Arslan M, Wiesner R H, Poterucha J J, Zein N N
Division of Gastroenterology and Hepatology and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Transplantation. 2001 Jul 27;72(2):272-6. doi: 10.1097/00007890-200107270-00019.
Vaccination against hepatitis A (HAV) has been shown to be safe and effective in healthy subjects and in patients with chronic liver disease (CLD). The safety and efficacy of HAV vaccines in liver transplant (OLT) recipients have not been established. The objective of this study is to assess the safety and efficacy of inactivated hepatitis A vaccine in OLT recipients.
Thirty-seven HAV seronegative OLT recipients were enrolled. Patients received two doses of vaccine 6 months apart. Postvaccination IgG anti-HAV were determined at 1, 6, and 7 months after the first vaccine dose. Side effects were monitored for 3 days after each vaccination shot. An unvaccinated control group (45 patients) was followed for evidence of seroconversion. Seroconversion rate was also compared with those reported in healthy patients and in patients with chronic liver disease.
Testing was available for all the cases at 1 month, and for 26 and 23 patients at 6 and 7 months, respectively. Only 3 of 37 patients (8%) had seroconversion at 1 month. At 6- and 7-month time points, 5 of 26 (19%) and 6 of the 23 (26%) patients had seroconversion, respectively. Vaccine responders had higher total white blood cell count and lymphocyte count and were further out from transplant compared with nonresponders. None of the unvaccinated patients had seroconversion over the follow-up time. Seroconversion rates in OLT recipients were significantly lower than that reported in healthy individuals (P=0.001) or in pre-OLT patients with CLD (P=0.001). All patients tolerated the vaccine well.
HAV vaccination is safe in OLT recipient. Efficacy of HAV vaccination in OLT recipients, as measured by a commercially available enzyme immunoassay, is low and alternative strategies should be developed to improve response rate.
甲型肝炎（HAV）疫苗已被证明在健康受试者和慢性肝病（CLD）患者中安全有效。HAV疫苗在肝移植（OLT）受者中的安全性和有效性尚未确立。本研究的目的是评估灭活甲型肝炎疫苗在OLT受者中的安全性和有效性。
纳入37例HAV血清学阴性的OLT受者。患者每隔6个月接种两剂疫苗。在第一剂疫苗接种后的1、6和7个月测定接种后抗-HAV IgG。每次接种后3天监测副作用。对未接种疫苗的对照组（45例患者）进行血清转化证据的随访。还将血清转化率与健康患者和慢性肝病患者报告的转化率进行比较。
所有病例在1个月时均进行了检测，6个月和7个月时分别有26例和23例患者进行了检测。37例患者中只有3例（8%）在1个月时出现血清转化。在6个月和7个月的时间点，26例患者中有5例（19%）和23例患者中有6例（26%）分别出现血清转化。与无反应者相比，疫苗反应者的总白细胞计数和淋巴细胞计数更高，且距离移植时间更远。在随访期间，未接种疫苗的患者均未出现血清转化。OLT受者的血清转化率显著低于健康个体报告的转化率（P=0.001）或OLT前CLD患者报告的转化率（P=0.001）。所有患者对疫苗耐受性良好。
HAV疫苗在OLT受者中是安全的。通过市售酶免疫测定法测量，HAV疫苗在OLT受者中的疗效较低，应制定替代策略以提高反应率。
