Is vaccination against hepatitis B infection indicated in patients waiting for or after orthotopic liver transplantation?
It is a common practice to immunize patients against hepatitis B infection while they are waiting for liver transplantation, but the efficacy of this practice is unclear. This is a retrospective analysis of the antibody response to 20 microg of a recombinant hepatitis B vaccine in patients waiting for and after liver transplantation. The response to vaccination was measured 1-3 months after completion of the vaccination series. The risk of acquiring hepatitis B virus after liver transplant was determined by reviewing the results of tests for hepatitis B infection in 171 patients who underwent transplantation for non-hepatitis B diseases and who had not been vaccinated. Fifty-seven patients awaiting transplantation were eligible for the study, and a response to vaccination was observed in only 9 (16%). Patients with cholestatic liver disease had a significantly higher response (6 of 14; 43%) compared with noncholestatic liver disease (3 of 43; 7%; P = .004). Forty-five liver transplant recipients were immunized against hepatitis B after transplantation, and only 3 (6.7%) developed an antibody response. The frequency of posttransplant hepatitis B infection in the 171 patients who were not immunized and who lacked any evidence of hepatitis B infection pretransplantation was 4 of 171 (2.3%). The response rate to immunization with a recombinant hepatitis B vaccine in patients with chronic liver disease who are waiting for a liver transplant and after transplantation is poor. Given the poor response to vaccination and the low risk of acquiring hepatitis B virus after transplantation, centers need to reconsider the routine use of the hepatitis B virus vaccine in patients awaiting liver transplantation.
Chalasani
N
N
Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA.
Smallwood
G
G
Halcomb
J
J
Fried
M W
MW
Boyer
T D
TD
D000328:Adult; D000917:Antibody Formation; D005260:Female; D006509:Hepatitis B / Q000453:epidemiology / Q000276:immunology* / Q000517:prevention & control*; D017325:Hepatitis B Vaccines / Q000276:immunology*; D006801:Humans; D008107:Liver Diseases / Q000276:immunology*; D016031:Liver Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D014614:Vaccines, Synthetic
D017325:Hepatitis B Vaccines; D014614:Vaccines, Synthetic