title: High prevalence of hepatitis B nonimmunity in vaccinated pediatric liver transplant recipients.
abstract: Durable protection from hepatitis B virus (HBV) and other vaccine-preventable diseases assumes great importance due to improved long-term patient and graft survival rates in pediatric liver transplantation. Vaccine immunogenicity data in transplanted children is limited. This was a cross-sectional, single-center, point-prevalence study evaluating HBV immunity in 160 pediatric liver transplant recipients. Patients with hepatitis B surface antibody levels <10 IU/L were considered nonimmune. Predictor variables for nonimmunity identified in univariate analyses were later analyzed within a logistic regression model. All subjects received the full HBV vaccination series prior to transplant. The majority (67%) of previously immunized pediatric liver transplant patients were nonimmune. Older children (p < 0.001) and children who were further out from transplant (p < 0.001) were more likely to be nonimmune in univariate analyses, but only time from transplant was a significant predictor of nonimmunity in a logistic regression model (odds ratio 1.3, p < 0.001 at 1 year). The mean time since transplant was 5.6 years ± 4.6. Markers of nutrition, immunosuppression, white blood cell parameters and type/severity of disease did not correlate with HBV immunity. Information on the anamnestic response to boosting or revaccination is needed to adequately address this vulnerable group.
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, TX; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, Houston, TX.
authors.forename: D H
authors.initials: DH
authors.lastname: Leung
authors.forename: M
authors.initials: M
authors.lastname: Ton-That
authors.forename: J M
authors.initials: JM
authors.lastname: Economides
authors.forename: C M
authors.initials: CM
authors.lastname: Healy
mesh_terms: D000367:Age Factors; D000906:Antibodies / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006509:Hepatitis B / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control*; D006514:Hepatitis B Surface Antigens / Q000276:immunology; D017325:Hepatitis B Vaccines / Q000276:immunology* / Q000627:therapeutic use*; D006515:Hepatitis B virus / Q000276:immunology* / Q000302:isolation & purification; D006801:Humans; D008099:Liver / Q000473:pathology / Q000821:virology; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D066027:Transplant Recipients; D014481:United States
chemical_list: D000906:Antibodies; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines
keywords: Clinical research/practice; infection and infectious agents; infectious disease; liver disease: infectious; liver transplantation/hepatology; pediatrics; preventive healthcare; viral: hepatitis B