Immunization with an adjuvant hepatitis B vaccine in liver transplant recipients: antibody decline and booster vaccination with conventional vaccine.

Patients after orthotopic liver transplantation (OLT) due to hepatitis B virus (HBV)-related disease are at risk of endogenous hepatitis B reinfection and may receive life long prophylaxis with hepatitis B hyperimmunoglobulin (HBIG). In a previous study 16 of 20 OLT patients were immunized successfully with an adjuvant hepatitis B vaccine. To maintain protective antibody levels under immunosuppressive therapy, 11 of these patients were revaccinated with a double dosed conventional hepatitis B vaccine. Median interval between last vaccination and booster was 24 months (range 22-31 months). Antibody titres against hepatitis B surface antigen (anti-HBs) were monitored at the day of booster vaccination (day 0), at day 7 and day 28. At day 0, all vaccinees but one had anti-HBs titres greater than 500 IU/L (median 1,925 IU/L, range 196-7,612 IU/L). Maximum antibody titres after previous vaccination declined by a median of 82% (range 47-96%). After booster vaccination the anti-HBs titre increased significantly by a median factor of 2.42 (P<0.05). In conclusion, the majority of liver transplant recipients who previously had responded to adjuvant hepatitis B vaccine exhibited sufficient immunocompetence to produce a substantial antibody response after booster immunization with a conventional vaccine.