Hepatitis A Immunity and Paediatric Liver Transplantation-A Single-Centre Analysis
Tobias Laue1, Johanna Ohlendorf1, Christoph Leiskau1,2
1Division of Paediatric Gastroenterology and Hepatology, Department of Paediatric Liver, Kidney and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany.
Insights
Hepatitis A virus (HAV) vaccination rates are low in children awaiting liver transplants. Early vaccination is crucial for developing immunity in this high-risk pediatric population before transplantation.
Area of Science:
- Pediatric Gastroenterology
- Transplant Immunology
- Infectious Disease Prevention
Background:
- Children undergoing liver transplantation face significant infection risks, including from Hepatitis A virus (HAV).
- While HAV is often mild in children, severe cases and fatalities have been reported, highlighting the need for prevention.
- Limited data exists on Hepatitis A vaccination coverage in pediatric liver disease patients, especially those transplanted young.
Purpose of the Study:
- To assess Hepatitis A virus (HAV) immunity in pediatric liver transplant recipients.
- To evaluate HAV vaccination rates and seroprotection before and after liver transplantation.
- To identify factors influencing HAV immunity in this vulnerable pediatric cohort.
Main Methods:
- Retrospective, observational, single-center study analyzing vaccination records of pediatric liver transplant recipients.
- Inclusion of 229 out of 279 transplanted children (82.1%) between 2003 and 2021.
- Assessment of anti-HAV-IgG positivity after one or two vaccine doses and correlation with transplantation timing.
Main Results:
- Only 41.7% of eligible children (≥1 year old) received at least one HAV vaccine dose before transplantation.
- Post-vaccination, 38.5% (one dose) and 90.6% (two doses) achieved anti-HAV-IgG positivity.
- Shorter interval between vaccination and transplantation was a risk factor for lack of immunity in those receiving a single dose.
Conclusions:
- Hepatitis A vaccination rates are suboptimal in pediatric liver transplant candidates.
- Two vaccine doses are highly effective in achieving seroprotection, which remains stable post-transplant.
- Earlier initiation of HAV immunization in pediatric liver transplant candidates is recommended to ensure adequate immunity.
Abstract:
Following paediatric solid organ liver transplantation, risk of infection is high, both in the short and long term. Even though an infection with hepatitis A virus (HAV) is often asymptomatic and self-limited in children, some case studies describe severe cases leading to death. Vaccinations offer simple, safe and cheap protection. However, data on vaccination rates against hepatitis A in children with liver disease are scarce. Moreover, the vaccine is only approved from the age of one year old. At the same time, up to 30% of children with liver disease are transplanted within the first year of life, so the window of opportunity for vaccination is limited. This retrospective, observational, single-centre study examines the HAV immunity in paediatric liver transplant recipients before and after the first year of transplantation. Vaccination records of 229 of 279 (82.1%) children transplanted between January 2003 and June 2021 were analysed. Of 139 eligible children aged ≥ 1 year old, only 58 (41.7%) were vaccinated at least with one HAV dose prior to transplantation. In addition, seven patients received the vaccine below one year of age. After one or two doses, 38.5% or 90.6% of 65 patients were anti-HAV-IgG positive, respectively. This percentage remained stable up to the first annual check-up. For children vaccinated only once, a shorter interval from vaccination to transplantation is a risk factor for lack of immunity. Thus, HAV immunisation should be started earlier in liver transplant candidates to improve immunity in this high-risk group.
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