Reply to: Optimal hepatitis B vaccination schedule for cirrhotic patients: a still unanswered question.

We read the letter of Giraldez-Gallego et al. Our data show that hepatitis B vaccination in patients with advanced cirrhosis leads to a poor response despite the implementation of a double dose accelerated schedule (starting at the hospital admission) and the nursing effort to reinforce the vaccination compliance after discharge(1) . The reasons for a lower response to vaccination in liver transplantation (LT) candidates were not clear, as we explained in our discussion. We did not find a direct correlation between the MELD score and the immunogenicity, but it is relevant to notice that LT candidates had worse MELD score (12[8-16]) compared with the remaining population (9[6-10], p<0.05). As Giraldez-Gallego et al. mentioned we had a high dropout rate (due to patient rejection/overlook or LT) that emphasizes the difficulties of HBV vaccination in patients with advance liver disease beyond the poor immunogenicity.