Expectation of impaired response to recombinant hepatitis B vaccination

A controlled trial of hepatitis B vaccination with recombinant antigen was undertaken in 18 hemodialysed end-stage renal failure (ESRD) patients (P) and 16 members of our staff (controls, C). In order to identify expected nonresponders (NR), we monitored T lymphocyte (Tc) subsets, peripheral blood mononuclear cells (PBMC), total leukocytes (WBC) and IgG. After 3 vaccine doses of 40 and 20 IU, respectively, for P and C, at 0, 1 and 6 months, 11 P(61.1%) and all C (100%) responded, as in previous reports [1-3]. The 7 NR presented lower CD4+ Tc fraction, compared to responders (R) and C (p less than 0.05), and higher monocyte (p less than 0.00001) and WBC (p less than 0.002) counts, with lower lymphocyte fraction (p less than 0.001), compared to R. We suggest that NR could represent a selected group of ESRD patients, screenable by these easily detectable features, probably markers of a specific immune dysfunction.