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Hepatitis B vaccination in heart transplant candidates
W Quinton Foster1, Angela Murphy, David J Vega
1Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Insights
Hepatitis B virus (HBV) vaccination was successful in about half of advanced heart failure patients, particularly Status 2 individuals. Early vaccination may help use more hepatitis B core antibody-positive donors.
Area of Science:
- Cardiology
- Immunology
- Transplantation
Background:
- Limited heart donor pool necessitates strategies like using hepatitis B core antibody-positive (HBcAb(+)) donors.
- A protocol for hepatitis B virus (HBV) vaccination was initiated for transplant candidates in 2001.
- The efficacy of HBV vaccination in advanced heart failure patients was unknown.
Purpose of the Study:
- To evaluate the efficacy of HBV vaccination in patients with advanced heart failure.
- To determine seroconversion rates after a 3-dose HBV vaccine series.
- To identify patient characteristics associated with successful vaccination.
Main Methods:
- Retrospective chart review of patients completing the HBV vaccine series and post-vaccination titers.
- Analysis of patient characteristics and donor serologies.
- Definition of seroconversion as a hepatitis B surface antibody (HBsAb) titer >10 mIU/ml.
Main Results:
- Twenty-nine patients completed the vaccine series; 13 (45%) initially seroconverted.
- Sixteen patients were non-seroconverters; 2 of 3 who completed a repeat series seroconverted.
- Seroconverters showed higher ejection fractions, lower creatinine, and better functional status; Status 1B patients did not seroconvert.
Conclusions:
- HBV vaccination achieved success in approximately 50% of advanced heart failure patients, notably Status 2 patients.
- Early vaccination initiation could increase the use of HBcAb(+) donors.
- HBV vaccination is unlikely to benefit Status 1 patients.
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.
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