Is vaccination against hepatitis B infection indicated in patients waiting for or after orthotopic liver transplantation?

• Published in: Liver Transplantation and Surgery 1998-03, Vol.4 (2), p.128-132
• Main Authors: Chalasani, Naga, Smallwood, Greg, Halcomb, Joanne, Fried, Michael W., Boyer, Thomas D.
• Format: Article
• Language: English
• Subjects: Adult; Antibody Formation; Antibody response; Female; Hepatitis B; Hepatitis B - epidemiology; Hepatitis B - immunology; Hepatitis B - prevention & control; Hepatitis B Vaccines - immunology; Hepatitis B virus; Humans; Liver diseases; Liver Diseases - immunology; Liver transplantation; Liver Transplantation - immunology; Male; Middle Aged; Retrospective Studies; Risk; Risk factors; Vaccination; Vaccines; Vaccines, Synthetic
• ISSN: 1074-3022; 1527-6465; 1527-6473
• DOI: 10.1002/lt.500040208

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 μg 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.