Hepatitis B virus immunization with an adjuvant containing vaccine after liver transplantation for hepatitis B‐related disease: failure of humoral and cellular immune response

Summary Long‐term hepatitis B reinfection prophylaxis after liver transplantation with hepatitis B immunoglobulin (HBIG) and nucleoside analogues is expensive and inconvenient. Studies evaluating humoral immune responses to hepatitis B virus (HBV) vaccines showed conflicting results. Best results were achieved under continuous HBIG administration with an adjuvant–containing HBsAg vaccine. In the present study, 8 patients who had been HBsAg positive and HBV DNA negative prior to liver transplantation were immunized with HBsAg‐vaccine containing the adjuvant 3‐deacylated monophosphoryl‐lipid‐A. Vaccination was started after discontinuation of HBIG. Six vaccinations were administered at weeks 0, 2, 4, 12, 16 and 24. Humoral (anti‐HBs titres) and cellular (enzyme‐linked immunospot assay and fluorescence‐activated cell sorting analysis) immune responses were studied. Only one of eight patients responded with a humoral immune response (maximum anti‐HBs titre 561 U/l). In this patient, decrease of anti‐HBs titre before vaccination was significantly slower than in the other seven patients and anti‐HBs did not become negative before first vaccination. A T‐cell response to HBsAg could not be detected in any of the patients. The responder was the only patient who showed a T‐cell response to HBcAg. In conclusion, the adjuvant‐containing vaccine did not induce a humoral or a detectable cellular immune response in most patients. Patient‐related preconditions and concomitant HBIG administration should be further investigated as possible predictors for response.