Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: The risk of developing hepatitis B after liver transplantation remains high in nonimmune patients receiving an allograft from a hepatitis B core antibody positive (HBcAb+) donor. This risk can be mitigated by the use of lifelong prophylaxis with antivirals or by vaccination followed by seroconversion. In March 2019, our center implemented a pilot study enabling transplant pharmacists to screen patients undergoing liver transplant evaluation and HBcAb+ liver transplant recipients for Heplisav-B® vaccination eligibility and subsequently order Heplisav-B® for administration at their next appointment. The purpose of this study was to determine if pharmacist-initiated hepatitis B vaccination improves vaccination rates in pre- and post-liver transplant patients.
*Methods: This single-center, retrospective review included patients undergoing liver transplant evaluation and HBcAb+ liver transplant recipients seen in transplant clinic between March 1, 2019 and October 1, 2019. Patients with active hepatitis B or C infection, HIV, those already vaccinated or immune to hepatitis B (surface antibody level > 12mIU/mL), or those transplanted prior to 2013 were excluded. Hepatitis B vaccination rates after implementation of pharmacist-driven vaccination management were compared to a historical control group.
*Results: Of the 259 patients screened after the implementation of pharmacist-driven Heplisav-B® vaccination management, 82 were identified as potential vaccine candidates: 75 undergoing liver transplant evaluation and 7 HBcAb+ liver transplant recipients. Prior to the pilot, vaccination rates were low with 32% of patients undergoing liver transplant evaluation and 2% of patients who received a HBcAb+ liver receiving vaccination. After the implementation of the pharmacist-driven vaccination pilot, vaccination rates increased to 48% (n=36) of patients undergoing liver transplant evaluation and 43% (n=3) of HBcAb+ liver transplant recipients (P<0.05). Heplisav-B® was ordered by a pharmacist for 85% (n=64) of patients undergoing liver transplant evaluation and for 86% (n=6) of HBcAb+ liver transplant recipients. Overall, 56% of ordered Heplisav-B® vaccinations were administered.
*Conclusions: Pharmacist-driven vaccination management significantly improved vaccination rates in patients undergoing liver transplant evaluation and in those that received a HBcAb+ liver. There is potential for even higher vaccination rates, as approximately half of the vaccines ordered were administered.
To cite this abstract in AMA style:Reid A, Todd S, Morrison M, Adams A. Pharmacist Initiated Hepatitis B Vaccinations in Liver Transplant Recipients [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/pharmacist-initiated-hepatitis-b-vaccinations-in-liver-transplant-recipients/. Accessed December 2, 2020.
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