Hepatitis B vaccination in heart transplant candidates

Abstract

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.