HEPATITIS-B VACCINATION AND DETERMINATION OF IMMUN RESPONSE IN CHRONIC HEMODIALYSIS PATIENTS

Hepatitis-B is stili a problem in dialysis units and the number of nonresponders to hepatitis-B vaccination is relatively high in patients on regular hemodialysis treatment. The reason for low seroconversion rates in hemodialyzed patients is poorly understood. Fifteen dialysis patients; 6 females, 9 males aged between 12 to 60 years underwent the following schedule of vaccination: a 40 μg dose of recombinant vaccine (Gen Hevac B Pasteur) at 0, 1, 2 and 6 months. The T lymphocyte subsets and stimulation indices, total IgG levels and major HLA-Class I and II antigens were evaluated, for the changes of immune response at Is ', 2 nd , 6th and 12th months. The seroconversion (AntiHBs >10mIU/L) was 20%, 67%, 64% and 63.7% at the 1st , 2nd , 6th and 12th months respectively. There was no statistically significant difference between the basal values of T lymphocyte subsets of the patients and the control group (p>0.05). T4IT8 ratio at 2th month, CD8 levels at 6th and 12th months, CD4 levels at 12nd month were lower when compared with the basal values for T4IT8 ratio, the levels at 1st and 2nd months for CD8, and the levels at 2nd month for CD4 (p 0.05 and p<0.05). The difference between the immune parameters of the nonresponders and responders were not statistically significant (p>0.05). The lymphocyte stimulation indices of two nonresponder patients were low,. In addition, all nonresponder patients had HLA-Ai and three of them had HLA-DR2 . In conclusion, we have shown that low seroconversion rates to HBV vaccine in hemodialyzed patients can be associated with several immune defects.