S1060 Rates of Vaccine Administration After Liver Transplantation at a Large Tertiary Care Center

Abstract

INTRODUCTION: There is clear evidence that vaccination prevents morbidity and mortality in high risk populations. We evaluated the quality of vaccination in liver transplant recipients at our institution and to what extent there is adherence to current guidelines. METHODS: A retrospective review of patients transplanted between 1/2015 and 1/2018 at our institution was performed. Data collected included patient demographics, travel distance to transplant center, insurance provider and primary care provider (PCP) visits. Vaccination status and eligibility for Influenza (IV), Pneumococcus (PV), Hepatitis-A (HAV) and B (HBV), Tdap and Td (TdV) were obtained through our EMR and the Michigan Care Improvement Registry. Statistics were calculated using analysis of variance (ANOVA), chi-square, Fisher’s exact test and Wilcoxon Rank Sum Test. RESULTS: 406 patients were evaluated with 336 (83.0%) Caucasians, 44 (10.8%) African-Americans, 15 (3.7%) Hispanics with ages ranging from 21-77 years old. 173 (42.6%) patients received the influenza vaccine in the year prior to transplant whereas only 97 (23.9%) were vaccinated in the year following transplant. 92 (33%) vaccine eligible patients were vaccinated for HAV pre-transplant with 66 (23.7%) patients vaccinated post-transplant, 121 (29.8%) of patients remained unvaccinated. 116 (31.4%) were vaccinated for HBV pre-transplant and 20 (5.4%) post-transplant, leaving 233 (57%) unvaccinated. PV rates increased from 185 (45.6%) to 267 (66%) post-transplant, TdaP 168 (41.4%) to 208 (51.2%) and Td 34 (8.4%) to 40 (10.0%) post-transplant respectively. Post-transplant vaccination was consistently associated with pre-transplant primary care visits (PV: 33.8% vs 57.3% P < 0.001, IV: 54.6% vs 45.6% P = 0.121, HAV: 63.6% vs 45.1% P = 0.008, HBV 50% vs 47.9%, Tdap: 50.0% vs 36.9% P = 0.121). Shorter distance to the transplant center, private insurance, female gender and pre-transplant influenza vaccine administration were also associated with a trend towards higher vaccine rates post-transplant (Table 2). CONCLUSION: Our data reveals vaccination rates in liver transplant recipients decline significantly in the post-transplant period. Additionally, a significant number of at-risk individuals remain unvaccinated. Pre-transplant habits such as regular PCP visits, IV administration and locating close to the transplant center could help improve uptake. As a result of this data, ensuring regular PCP visitation upon transplant listing will be implemented as a quality improvement initiative.Table 1.: Demonstrating Vaccination rates pre- and post-liver transplantTable 2.: Demonstrating factors influencing vaccine uptake. (F) = Fisher Exact Test, (W) = Wilcoxon Rank Sum Test, (C) = Chi Square Analysis. Distance in Miles