Vaccination against hepatitis B virus in cirrhotic patients on liver transplant waiting list

Patients with cirrhosis may fail to respond to antihepatitis B vaccine. An adequate response would be especially interesting when patients are on a li ver transplant waiting list. Posttransplantation de novo hepatitis B has be en well documented. One possible source is the grafting of organs from hepa titis B surface antigen (HBsAg)-negative, antibody to HBsAg (anti-HBs)posit ive, antibody to hepatitis B core antigen-positive donors. The achievement of high titers of anti-HBs could be protective in this setting. We studied prospectively the response rate to recombinant hepatitis B vaccine (3 40-mu g doses administered at 0, 1, and 2 months) in 62 patients with end-stage liver disease awaiting liver transplantation. Twenty-two patients showed an tibody response (44%). A further 3 doses were administered in 15 of 28 nonr esponders and were effective in 9 patients, Thus, the response rate reached 62% (31 of 50 patients completing 1 or 2 vaccination schedules before live r transplantation). Classic hepatitis B vaccination studies of patients wit h cirrhosis yield lower response rates. Vaccination with this double-dose s chedule should be considered in such patients before liver transplantation.