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Immunization with an adjuvant hepatitis B vaccine after liver transplantation for hepatitis B‐related disease

Patients who undergo transplantation for hepatitis B virus (HBV)‐related diseases are treated indefinitely with hepatitis B hyperimmunoglobulin (HBIG) to prevent endogenous HBV reinfection of the graft. Active immunization with standard hepatitis B vaccines in these patients has recently been reported with conflicting results. Two groups of 10 liver transplant recipients on continuous HBIG substitution who were hepatitis B surface antigen (HBsAg) positive and HBV DNA negative before transplantation were immunized in a phase I study with different concentrations of hepatitis B s antigen formulated with the new adjuvants 3‐deacylated monophosphoryl lipid A (MPL) and Quillaja saponaria (QS21) (group I/vaccine A: 20 μg HBsAg, 50 μg MPL, 50 μg QS21; group II/vaccine B: 100 μg HBsAg, 100 μg MPL, 100 μg QS21). Participants remained on HBIG prophylaxis and were vaccinated at weeks 0, 2, 4, 16, and 18. They received 3 additional doses of vaccine B at bimonthly intervals if they did not reach an antibody titer against hepatitis B surface antigen (anti‐HBs) greater than 500 IU/L. Sixteen (8 in each group) of 20 patients (80%) responded (group I: median, 7,293 IU/L; range, 721–45,811 IU/L anti‐HBs; group II: median, 44,549 IU/L; range, 900–83, 121 IU/L anti‐HBs) and discontinued HBIG. They were followed up for a median of 13.5 months (range, 6–22 months). The vaccine was well tolerated. In conclusion, most patients immunized with the new vaccine can stop HBIG immunoprophylaxis for a substantial, yet to be determined period of time. (Hepatology 2003;38:811–819).