title: Hepatitis B vaccination in heart transplant candidates.
abstract: BACKGROUND
  Various options have been proposed to expand the limited heart donor pool, including candidate vaccination permitting use of hepatitis B core antibody-positive (HbcAb(+)) donors. From 2001 to 2004, 263 potential heart donors were turned down due to hepatitis B core antibody positivity. In 2001, we initiated a protocol of a routine vaccination against hepatitis B virus (HBV) at transplant evaluation. The efficacy of HBV vaccination in patients with advanced heart failure is not known.
  
  
  METHODS
  A single-center retrospective chart review was completed for patients who successfully completed the 3-dose HBV vaccine series and hepatitis B surface antibody (HBsAb) post-vaccination titer. We reviewed post-vaccine quantitative titers, patient characteristics and donor serologies. Seroconversion was defined as a HBsAb titer >10 mIU/ml.
  
  
  RESULTS
  Twenty-nine patients had a complete vaccine series with HBsAb quantitative titers. Thirteen patients seroconverted on the initial attempt. Sixteen were non-seroconverters. Of these, 6 were transplanted prior to repeat series with titers, 7 remain wait-listed awaiting complete repeat series, and 3 completed a repeat series, of whom 2 seroconverted. None of the Status 1B patients seroconverted. Seroconverters had higher ejection fractions (EFs), lower serum creatinine levels and higher functional status.
  
  
  CONCLUSIONS
  HBV vaccination of patients with advanced heart failure was successful in approximately 50% of patients and was most successful in Status 2 patients. Early initiation of the vaccine series may increase utilization of HBcAb(+) donors. HBV vaccination is unlikely to benefit Status 1 patients.
authors.affiliation: Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: W Quinton
authors.initials: WQ
authors.lastname: Foster
authors.forename: Angela
authors.initials: A
authors.lastname: Murphy
authors.forename: David J
authors.initials: DJ
authors.lastname: Vega
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Smith
authors.forename: Brenda J
authors.initials: BJ
authors.lastname: Hott
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Book
mesh_terms: D000328:Adult; D000917:Antibody Formation; D005260:Female; D016027:Heart Transplantation; D006509:Hepatitis B / Q000517:prevention & control / Q000635:transmission; D006510:Hepatitis B Antibodies / Q000276:immunology; D006512:Hepatitis B Core Antigens / Q000276:immunology; D017325:Hepatitis B Vaccines / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D014019:Tissue Donors; D014850:Waiting Lists
chemical_list: D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D017325:Hepatitis B Vaccines