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High-dose hepatitis B vaccine in patients waiting for lung transplantation
Mary S Hayney1, Deborah L Welter, Ann Marie Reynolds
1School of Pharmacy, University of Wisconsin, Madison 53705-2222, USA. mshayney@pharmacy.wisc.edu
Study Objective:
To increase the response rate to hepatitis B vaccine in patients awaiting lung transplantation.
Design:
Historically controlled, open-label study.
Setting:
Lung transplant clinic at a university hospital.
Subjects:
Twenty-seven consecutive individuals with end-stage pulmonary disease who were enrolled to accrue 15 subjects who would complete the vaccine series before transplantation; and 27 lung transplant recipients who were immunized with the conventional dose before the study and served as historical controls.
Intervention:
Intramuscular injection of high-dose hepatitis B vaccine 40 microgram at 0, 1, and 6 months.
Measurements And Main Results:
Hepatitis B surface antibody (anti-HBs) concentrations were measured 1-2 months after completing the high-dose series. Individuals with undetectable anti-HBs received additional vaccine to a maximum of six doses. The response rate to the series was compared with that in the control group. Seventeen individuals in the high-dose group and 14 controls met the study criterion of complete vaccine series before transplantation. The former had a much higher response rate than the latter (9 [53%] vs 1 [7%], p<0.01). Four of six patients who received additional doses of vaccine seroconverted. Two of them underwent transplantation shortly after completing the three-dose series.
Conclusion:
The high-dose hepatitis B vaccine series produced a protective immune response in lung transplant recipients; however, the response was suboptimal, and alternative immunization strategies should be studied.