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Response to hepatitis B vaccination by liver transplant candidates

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Abstract

Liver transplantation (OLTx) is a procedure offered to individuals with advanced liver disease who are expected to live less than a year. Despite improvement in the care of transplant recipients, these patients are exposed to large volumes of blood and, as a result, are at risk to acquire hepatitis. Currently, the only vaccines available for the prevention of hepatitis are those that induce a response to HBsAg. In this study, 144 patients awaiting OLTx and 15 controls were vaccinated three times, once a month, intramuscularly in the deltoid using the Merck Hepatovax plasma-derived vaccine. This schedule was continued regardless of whether or not OLTx occurred before the series was completed. For the 15 controls, the response rate was 93% and for individuals with end-stage liver disease, it ranged from 44 to 54% (P<0.004). No difference in the percentage of those developing antibody was detected between groups based upon disease indication or whether the vaccination series was completed before or after OLTx. Of the following: WBC, lymphocytes (percent and number), CD3+ cells (percent and number), CD4+ cells (percent and number), CD8+ cells (percent and number), CD4+/CD8+ ratio, and B cells (percent and number), only the absolute WBC (P<0.05) distinguished between those who did and did not develop antibody. These data suggest: (1) those with chronic liver disease respond less well to Hepatovax than do controls; (2) a rapid sequence of vaccinations is capable of producing antibody in normals and those with liver disease; (3) no difference is evident between those who completed their vaccination schedule before or after OLTx; and (4) among patients with chronic advanced liver disease, a higher total WBC is associated with an increased rate of seroconversion.

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Authors and Affiliations

  1. Department of Surgery, Graduate School of Public Health, University of Pittsburgh School of Medicine, 15261, Pittsburgh, Pennsylvania

    David H. Van Thiel MD, Lobna El-Ashmawy MD, Kristin Love BS, Judith S. Gavaler PhD & Thomas E. Starzl MD, PhD

  2. Division of Gastroenterology, Graduate School of Public Health, University of Pittsburgh School of Medicine, 15261, Pittsburgh, Pennsylvania

    David H. Van Thiel MD, Lobna El-Ashmawy MD, Kristin Love BS, Judith S. Gavaler PhD & Thomas E. Starzl MD, PhD

  3. Department of Epidemiology Graduate School of Public Health, University of Pittsburgh School of Medicine, 15261, Pittsburgh, Pennsylvania

    David H. Van Thiel MD, Lobna El-Ashmawy MD, Kristin Love BS, Judith S. Gavaler PhD & Thomas E. Starzl MD, PhD

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  1. David H. Van Thiel MD
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  2. Lobna El-Ashmawy MD
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  3. Kristin Love BS
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  4. Judith S. Gavaler PhD
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  5. Thomas E. Starzl MD, PhD
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Van Thiel, D.H., El-Ashmawy, L., Love, K. et al. Response to hepatitis B vaccination by liver transplant candidates. Digest Dis Sci 37, 1245–1249 (1992). https://doi.org/10.1007/BF01296567

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  • DOI: https://doi.org/10.1007/BF01296567

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