Hepatitis B Virus(HBV)-vaccine response rate in haemodialysis(HD) population is only40-70% than90% in general population, because of inflammatory immune-paralysis.
HD with polymethylmethacrylate(PMMA) membrane improved HBV-vaccine response in not responders patients previously vaccinated during conventional HD-filters use.
We wanted to evaluate if PMMA was better than traditional polysulfone in achieving HBV-seroconversion with a prospective randomized controlled trial, confirming previous literature data[Contine,Immunology2003; Duranti,MinervaMed2011]. Moreover, we tried to find other HBV-vaccine-response predictive factors, focusing on HDL cholesterol(HDL-C), which is known to have a pivotal role as modulator of adaptive immune response.
53patients were included in 2011HBV-vaccination campaign. In 2014 37patients were blindly randomized to PMMA(n=19), or polysulfone(n=18). They used the new filter for 3months before receiving 1°HBV-vaccination dose. Full course consists of three 40μg doses: 2°dose at1°month, 3°dose at6°month, HBsAb test at8°month.
2011campaign:
23responders(HBsAb ≥10IU/L), 30NotResponders. Responders(R) had higher HDL-Cs than NotResponders(NR)(R43.6±13.4mg/dl,IC95%:37.1-50.1mg/dl;NR34.6±7.6mg/dl,IC95%:31.9-37.4mg/dl;p=0.0018).
2014campaign:
7responders(37%) in PMMA, 11responders(61%) in polysulfone. Considering twelve2011NR included in 2014: 3responders in PMMA(3of8) and only one in polysulfone(1of4). HDL-C was not independently associated with response, but basal ApoA1, a main HDL-apolipoprotein(odd ratio1.28,z2.01,P>z0.044,IC95%:1.006-1.620;loglikelihoodchisquare20.17,Prob>Chi2=0.052).
HDL-Cs increased in PMMA group(mean-basal-HDL-C45.53±25.95mg/dl,mean-final52.68±33.07 mg/dl;p=0.0018) but not in polysulfone group(mean-basal-HDL34.22±11.05mg/dl,mean-final36.39±7.92mg/dl;p=0.13)(Figure1B). Considering 2011NRpatients, PMMA-driven-HDL-Cs-increase was even more impressing(mean-basal-HDL-Cs47.5±29.36mg/dl,mean-final60.12±38.2mg/dl;p=0.02), whereas polysulfone didn’t change HDL-Cs.
Campaigns joined together:
Responders had higher HDL-Cs than NotResponders(R45.04±22.87mg/dl,IC95%37.30-52.78mg/dl;NR36.03±10.29mg/dl;32.98-39.09mg/dl;p=0.0098)(Figure1A). Patients’age(odd ratio0.925,z-2.83,P>z0.005,IC95%:0.877-0.976) and basal-mean-HDL-Cs(odd ratio1.057,z2.08,P>z0.037,IC95%:1.003-1.114) were significantly and independently associated with HBsAb-response(log-likelihood-chi-square17.94,Prob>Chi2=0.0122).
Mean-HDL-Cs and basal ApoA1 are positive independent HBsAb-response predictors.
PMMA surprisingly increases HDL-Cs, in confront with polysulfone, probably improving inflammation.
PMMA is not usefull in naive patients, while in not responders subjects it could be used with positive results. Further controlled trials with a lager patients sample size are needed to confirm these observations.