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One‐year vaccination against hepatitis B virus with a MPL‐vaccine in liver transplant patients for HBV‐related cirrhosis

Conflicting results have been reported on vaccination against hepatitis B virus (HBV) as a prophylaxis against viral recurrence after liver transplantation. We investigated the efficacy of 1‐year, monthly vaccination using an adjuvant 3‐deacylated monophosphoryl‐lipid‐A (MPL) recombinant S vaccine initially administered together with hepatitis B immunoglobulins (HBIg) in 18 patients transplanted for HBV‐related cirrhosis. All received 12 vaccine doses (HBsAg, 20 mcg plus MPL, 50 mcg): the initial six doses (phase I) were administered within 7 days after intravenous HBIg (2000 IU), while the last 6 (phase II) following HBIg withdrawal. All patients received lamivudine during the study. Anti‐HBs titers were determined before each dose and then for 1 year after vaccination. After phase I anti‐HBs titers were greater than 100 IU/l in all patients and in three (16.6%) were greater than 500 IU/l. After phase II 10 patients (55.5%) achieved anti‐HBs titers greater than 100 IU/l and five (27.7%) greater than 500 IU/l. One year after vaccination eight patients (44.4%) maintained anti‐HBs titers greater than 100 IU/l, with a median titer of 234 IU/l (102–1205), and 2 (11.1%) greater than 500 IU/l. One‐year extended monthly vaccination with a MPL‐adjuvant recombinant vaccine induces a sustained protective anti‐HBs response in approximately half of transplant recipients.