RESUMO
INTRODUCTION: The response to hepatitis B (HB) vaccine remains suboptimal among chronic kidney disease patients. The aim of this study was to analyze the efficacy of a hepatitis B vaccination schedule with two 4-double doses of conventional vaccine and four doses of adjuvant vaccine in chronic kidney disease patients evaluated for renal transplantation. METHODS: In this prospective study, we recruited chronic kidney disease patients evaluated for renal transplantation to receive four 40-µg doses of hepatitis B virus vaccine (0, 1, 2 and 6 months) and another four 40 µg doses of hepatitis B virus vaccine and four 20 µg doses of adjuvant vaccine if they were nonresponders. AntiHBs titers were analyzed before every vaccine dose and 1 month after the fourth dose. RESULTS: One hundred fifty-five patients were enrolled in the study. The response to the vaccination increased until the seventh dose: first dose, 5.4%; second, 29.5%; third, 66.7%; fourth, 75.9%; fifth, 83.3%; sixth, 87.3%; seventh, 92.5%; and eighth, 93.8%. AntiHBs titers after the first and second vaccination with Engerix were 10 to 99 mIU/mL in the 12% and 7.7%, 100 to 999 mIU/mL in the 30.1%, and 46.2%, and 1000 mIU/mL in the 34.9% and 15.4%, respectively. Fendrix was administrated in 6.2% of the patients and 75% of them obtained a response. AntiHBc-positive patients obtained a response with one vaccination cycle in the 71.4%. The response was influenced by age and was greater in women. Adverse events were found in 11.5% of the patients (inflammation and/or local pain), which were less frequent in men (8.9% versus 16.1%) and similar for both vaccines. CONCLUSION: The response to the hepatitis B vaccination with four double doses of conventional vaccine and revaccination with the same schedule and adjuvanted vaccine shows a high response rate in chronic kidney disease evaluated for renal transplantation.
