*Purpose: Vaccination of solid organ transplant (SOT) candidates and recipients is vital to decrease infection-related morbidity and mortality. However, published reports have shown that adherence to vaccine recommendations in this population is low. Here we describe our heart transplant program’s rates of completion of hepatitis B (HBV) and pneumococcal vaccinations and identify potential opportunities for improvement.

*Methods: This single center retrospective study was performed at a 700 bed academic tertiary care center that provides comprehensive organ transplant services. The study cohort includes all adult heart transplant recipients transplanted between July 2013 and July 2018. Routine pre-transplant evaluation by Transplant Infectious Diseases (TxID) was implemented in the heart transplant program in 2015. We assessed demographics, cause of heart failure, pre- and post-transplant HBV immune status, and vaccination completion rates for HBV, pneumococcal conjugate vaccine (PCV13), and pneumococcal polysaccharide vaccine (PPSV23). We compared rates between patients who underwent pre-transplant TxID evaluation versus those who did not.

*Results: 43 adult heart transplant recipients were included in this study. The majority of the cohort was male (n=36, 83.7%) and had non-ischemic cardiomyopathy as the cause of heart failure (n=26, 60.4%). Median age was 49.6 years (range 18.5-69.5). All patients underwent pre-transplant serological screening for HBV; 12 patients (27.9%) were HBV-immune. Of the 31 HBV-nonimmune patients, 8 (25.8%) completed HBV vaccination series pre-transplant and 1 additional patient completed the series post-transplant (29.0% completion rate overall). Pre-transplant PCV13 and PPSV23 vaccination rates were 55.5% (24/43) and 46.5% (20/43). The majority of patients in the cohort were evaluated by TxID pre-transplant (n=33, 76.7%). A significantly greater percentage of patients completed PCV13 (72.7 vs 0.0%, P=<0.001) and PPSV23 (57.6 vs 10.0%, P=0.011) if a TxID evaluation was performed pre-transplant. HBV vaccination completion rates were not affected by TxID evaluation (30.4 vs 25.0%, P=>0.999).

*Conclusions: We found low rates of adherence to vaccination recommendations for HBV and pneumococcus in this heart transplant cohort. TxID consultation pre-transplant improved PCV13 and PPSV23 vaccination rates but did not impact HBV vaccination rates. Our data identify opportunities for improvement to ensure that this vulnerable patient population is appropriately vaccinated pre-transplant. Potential interventions include use of an accelerated HBV vaccination schedule, vaccination cards for SOT candidates to bring to each evaluation appointment, and electronic medical record alerts for overdue vaccinations.

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