Immunogenicity of hepatitis A vaccine in decompensated liver disease

OBJECTIVE: Hepatitis A can cause decompensation and death in patients with previous liver injury. The hepatitis A vaccine is recommended for patients with chronic liver disease. The aim of this study was to screen, immunize, and measure the safety and antibody response of the hepatitis A vaccine in liver failure and liver transplant patients. METHODS: This was a prospective immunization trial at a referral center for liver disease and liver transplantation. A total of 193 patients with seve re chronic liver disease were screened and 24 patients were vaccinated. Six teen end stage liver disease patients were compared with eight liver transp lant patients. Hepatitis A vaccinations using 1440 ELISA units were given a t 0 and 2 months. Serum hepatitis A antibody titers were measured after eac h vaccine dose. An antibody response greater than or equal to 33 mIU/ml was considered protective. RESULTS: Screening seropositive rate was 70 of 193 (36%) and 24 patients we re available for vaccination. The median antibody titer was markedly lower in liver transplant patients, 0.0 mIU/ml compared to liver failure patients 34.7 mIU/ml (p < 0.001). Liver transplant recipients did not respond to th e vaccine (0 of eight patients) compared with seven of 14 liver failure pat ients (seroconversion rate 50%, p = 0.02). CONCLUSIONS: Liver failure significantly reduces the antibody response to h epatitis A vaccine, and liver transplant recipients were unable to respond to the vaccine. Although this study was small, immunization should be consi dered early for susceptible patients with chronic liver disease because the development of liver failure may blunt the immunogenicity of the vaccine. (Am J Gastroenterol 1999; 94:1601-1604. (C) 1999 by Am. Cell. of Gastroente rology).