Abstract
BackgroundHepatitis B virus (HBV) immunity is recommended to optimize outcomes after solid organ transplantation (SOT). This study assessed the prevalence and predictors of HBV immunity at the time patients were placed on transplant waiting list over a period from 1997 to 2019 in a low HBV endemic region.MethodsData were obtained from the University Hospitals Leuven transplant database. Minors and patients with past/current HBV infection were excluded. From 1986, Belgian patients are covered by the universal infant vaccination; therefore, birth cohort was stratified in those born ≥1986 vs <1986.ResultsThe study population consisted of 3297 SOT candidates. HBV immunity rate was superior in renal transplant candidates (55.3%), and this number was 21.5%, 15.4% and 16.8% for liver, cardiac and pulmonary transplant candidates, respectively, P < .001. Among liver transplant candidates, HBV immunity rate was 14.8% in decompensated cirrhotic patients and 27.9% in those without advanced cirrhosis (P < .001). The overall immunity rate increased from 19.3% in period 1997‐2008 to 32.8% in 2009‐2019, P < .001. In multivariable analyses, younger age (odds ratio (OR) 95% confidence interval (CI): 0.97‐0.98, P < .001) and birth cohort ≥ 1986 (OR 95% CI: 1.18‐2.66, P = .006) were associated with increased HBV immunity.ConclusionAn increase in HBV immunity was observed over a 20‐year period related to the introduction of universal infant HBV vaccination. Nevertheless, this study highlights the low overall HBV immunity at the time of listing for organ transplantation and points out the need of an increased awareness and vaccination strategy at an early disease stage.
Highlights
Hepatitis B virus (HBV) screening of solid organ transplant (SOT) candidates is recommended to optimize outcomes after transplantation.[1, 2] Since achievement of adequate hepatitis B antibody levels (> 10 mIU/mL) prevents de novo HBV infection acquired during or after transplantation, non-immune solid organ transplantation (SOT) candidates should receive the HBV vaccine series.[3,4,5] Current licensed HBV vaccines are produced in Saccharomyces cerevisiae and vary in the amount of hepatitis B surface antigen (HBsAg) (20, 40μg).[6]
This study provides information on the prevalence of HBV immunity at the time SOT candidates were placed on the transplant waiting list over the period 1997 – 2019 in Belgium, a low endemic region for HBV
Between 1 January 1997 and 21 June 2019, 3739 unique patients with known HBV serology were listed for SOT at our centre
Summary
Hepatitis B virus (HBV) screening of solid organ transplant (SOT) candidates is recommended to optimize outcomes after transplantation.[1, 2] Since achievement of adequate hepatitis B antibody (anti-HBs) levels (> 10 mIU/mL) prevents de novo HBV infection acquired during or after transplantation, non-immune SOT candidates should receive the HBV vaccine series.[3,4,5] Current licensed HBV vaccines are produced in Saccharomyces cerevisiae and vary in the amount of hepatitis B surface antigen (HBsAg) (20, 40μg).[6]. A recent systematic review reported a poorer immune response in patients with end-stage renal disease with 24 – 42% seroprotection after standard-dose (20μg) HBV vaccination and 51 – 69% after double-dose (40μg) vaccination.[25] Low success rates of HBV vaccination have been reported in cardiac and pulmonary transplant candidates.[26, 27]. B virus (HBV) immunity is recommended to optimize outcomes after solid organ transplantation (SOT). HBV immunity rate was superior in renal transplant candidates (55.3%) and this number was 21.5%, 15.4% and 16.8% for liver, cardiac and pulmonary transplant candidates, respectively, p
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