Background:

Hepatitis B virus (HBV) vaccine series is recommended for all organ transplant candidates; high doses of vaccine are generally given to those with renal disease; however, limited data exist on immunogenicity of HBV vaccine dosing especially in populations without renal disease.

Methods:

We conducted a retrospective review of HBV immunization (using a high-(40ug), mid-(20ug), or low-(10ug) dose vaccine series) given to patients awaiting transplant in an established pre-transplant clinic from January 2014 to June 2017. The primary outcome was seroprotection defined as anti-HBs ≥ 10 IU/mL at least 4 weeks after completion of the vaccine series.

Results:

We screened 112 patients (65% males and median age 60 (range 21-74 years) who had a negative anti-HBs titer. The majority of these patients were candidates for lung (n=85) or heart (n=17) transplants while others were listed for kidney (n=5), liver (n=4), and pancreas (n=1) transplants. The most common comorbidity was diabetes (27%). Patients were receiving immunosuppression for their primary disease as follows: prednisone (n=49; 43.7%), mycophenolate (n=24; 21.4%), tacrolimus (n=8;7.1%), other (n=4;3.6%). 13/112 (11.6%) patients had received HBV vaccine previously. In the total cohort, 93/112 (83.0%) patients had the HBV vaccine initiated using the following HBV antigen doses: 40 [micro]g (n=39), 20 [micro]g (n=46), or 10 [micro]g (n=8). HBV vaccine series was not started in 19/112 (17.0%) or started but interrupted because patients underwent transplantation or died (29/112; 25.9%). 24 patients are currently in follow-up. Therefore, immunogenicity was tested in 40 patients after completing two (n=4) or three (n=36) doses of HBV vaccine series. Seroprotection was achieved in 17/40 (43%) patients. Seroprotection rates were significantly greater if high dose vaccine was used (11/18 (61.1%) seroprotected with 40[micro]g vs. 6/22 (27.3%) seroprotected with <40[micro]g; p=0.031). Prednisone use pre-transplant (16/40 patients) was associated with significantly reduced vaccine seroprotection (p=0.022). Older age was also associated with reduced seroprotection (median 63 vs. 58; p=0.001). Seroprotection rates did not significantly differ by organ type, mycophenolate use, presence of diabetes, GFR<30 ml/min, prior HBV vaccination, or use of accelerated vaccine courses.

Conclusion:

The immunogenicity of HBV vaccine in transplant candidates is suboptimal and may be diminished due to older age and prednisone use; However, protection is improved by using higher doses of HBV vaccine in those awaiting thoracic transplantation.

CITATION INFORMATION: Bosaeed M., AlJishi Y., Husain S., Rotstein C., Humar A., Kumar D. Evaluation of Hepatitis B Vaccination in Transplant Candidates Am J Transplant. 2017;17 (suppl 3).

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