Prospective analysis of the factors influencing the antibody response to hepatitis b vaccine in hemodialysis patients

doi:10.1016/S0272-6386(97)90036-6

American Journal of Kidney Diseases

Volume 29, Issue 2, February 1997, Pages 239-245

https://doi.org/10.1016/S0272-6386(97)90036-6 Get rights and content

Abstract

Hepatitis B vaccine is effective in producing protection against hepatitis B virus (HBV) infection in hemodialysis (HD) patients, but the antibody response is variable. To identify those factors implicated in the vaccine response, in a prospective study over a 24-month period, we vaccinated 80 seronegative patients on HD (group A) and monitored clinical, biochemical, and immunologic parameters. The protective immunity acquired by vaccination was compared with that developed through HBV infection in 22 age-matched HD patients (group B). The antiHBs antibody—seronegative patients followed a four-dose vaccination schedule (0, 1, 2, and 6 months) with 40 μg DNA-recombinant hepatitis B vaccine. One month after vaccination, 77.5% of the patients had seroconverted, and 72.5% achieved high antibody response, whereas 22.5% were nonresponders. Patients aged younger than 40 years seroconverted 100%; those aged 40 to 60 years, 75% (P < 0.01); and patients older than 60 years, 74% (P < 0.001). No differences between responders and nonresponders concerning sex, time on HD, HD dose, nutritional status, hemoglobin level, HD membrane, iPTH level, calcitriol treatment, or number of transfusions during vaccination were found. The presence of other factors, such as recombinant human erythropoietin (rHuEPO) therapy or hepatitis C virus (HCV) infection, did not significantly influence antibody responses to hepatitis B immunization. A greater frequency of DR3 (53.8% v 25.7%, P < 0.05), DR7 (53.8% v 18.6%, P < 0.01), and DQ2 (76.9% v 44.1%, P < 0.05), and a lesser frequency of A2 (7.7% v 37.2%, P < 0.05) were found in nonresponders compared with responders. Eighteen months after vaccination, the analysis showed similar antibody titers but lower seroconversion rates in group A as compared with group B. In conclusion, unresponsiveness to hepatitis B vaccine in HD patients was related to factors such as older age, the presence of DR3, DR7, and DQ2, and the absence of A2 alleles. Although the seroprotection produced by the vaccine was less than that achieved through natural HBV infection, our protocol of vaccination was sufficiently immunogenic and provided lasting protection.

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^☆: Presented in part in abstract form at the 32nd Congress of the EDTA-ERA, Athenas, June 11–14, 1995, at the 13th International Congress of Nephrology, Madrid, July 2–6, 1995, and at the 33rd Congress of the EDTA-ERA, Amsterdam, June 18–21, 1996.

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Original investigationProspective analysis of the factors influencing the antibody response to hepatitis b vaccine in hemodialysis patients☆

Abstract

Am J Med

J Hepatol

J Infect

Kidney Int

Am J Kidney Dis

Clin Immunol Immunopathol

Kidney Int

Cell

Vaccine

Lancet

Lancet

Genetic prediction of nonresponse to hepatitis B vaccine

N Engl J Med

Hepatitis C virus infection decreases the effective antibody response to hepatitis B vaccine in the hemodialysis patients

Clin Nephrol

Recombinant interferon as adjuvant to hepatitis B vaccine in hemodialysis patients

Hepatology

HLA-associated non-responsiveness to hepatitis B vaccine

Tissue Antigens

HLA genetic heterogeneity of hepatitis B vaccine response in hemodialyzed patients

Kidney Int

Non-responsiveness to hepatitis B vaccination in haemodialysis patients: Association with impaired TCR/CD3 antigen receptor expression regulating co-stimulatory processes in antigen presentation and recognition

Nephrol Dial Transplant

Microdroplet assay of human serum cytotoxins

Nature

Original investigation
Prospective analysis of the factors influencing the antibody response to hepatitis b vaccine in hemodialysis patients☆