A Randomized Trial of Serological and Cellular Responses to Hepatitis B Vaccination in Chronic Kidney Disease

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2018 Oct 11

PMID 30303980

Citations 6

Authors

Elizabeth N da Silva

Alan Baker

Jalila Alshekaili

Krishna Karpe

Matthew C Cook

Affiliations

Soon will be listed here.

Abstract

Background: Chronic kidney disease (CKD) is associated with an increased risk of hepatitis B infection and impaired seroconversion to hepatitis B vaccine (HBV). Studies examining augmented vaccine schedules to enhance seroconversion have so far been inconclusive. Furthermore, the defects responsible for impaired vaccine immunity in CKD have not yet been identified.

Methods: We studied serological and cellular responses to HBV in CKD to identify a defect in vaccine-induced cellular responses that could account for impaired seroconversion in CKD and clarify the effects of an augmented vaccine dose schedule. We compared these results with responses to seasonal influenza vaccination (Fluvax).

Results: We found a clear benefit in rates and magnitude of seroconversion after an augmented 40mcg HBV dose schedule in CKD. This permitted comparison of responders and non-responders. Serological non-responders with CKD exhibited reduction in CXCR3+CCR6- CXCR5+ memory T cells at baseline. Unlike Fluvax, HBV elicited a poor plasmablast (PB) response. Both vaccinations induced activation of the CXCR3+CCR6- CCR7- subset of circulating T follicular helper cells (cTFH), although this response was impaired in CKD after HBV.

Conclusions: CKD confers a specific T cell defect that contributes to the impaired seroconversion to HBV.

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