Hepatitis B vaccination in heart transplant candidates

Abstract

Methods: RSV was identified on nasopharyngeal and throat swabs (NPS) using indirect fluorescent antibody (IFA) in 17 symptomatic patients and confirmed by viral culture in 14/17. Patient age was 43 Ϯ 15(18 -63) years, m:f ϭ10:7, single: bilateral LTX ϭ 5:12, post-op 1444Ϯ1272(61-4598) days . Underlying diagnoses included cystic fibrosis (8), emphysema (7) and pulmonary fibrosis (2). All 17 received intravenous ribavirin (33 mg/kg on day 1 and 20 mg/kg/day thereafter in 3 divided doses) with oral prednisolone (1mg/kg) until repeat NPS were negative for RSV on IFA. Median therapy was 8(6 -14) days. Results: There was no mortality. No patient developed BOS. FEV 1 fell from 2.1Ϯ1.0L(0.7-3.7) to 1.8Ϯ0.9L(0.5-3.6) (pϽ0.001) but recovered to 2.1Ϯ 0.9(0.7-3.7) within 2 months and was maintained at a follow-up of 361Ϯ321(10 -838) days. Complications included mild hemolytic anemia (Hb fell from 124Ϯ21g/l(84 -154) to 107Ϯ18g/l(75-138): pϭ0.005). Cost savings were $US13,811/ case versus nebulised therapy at 6gm/d (pϽ0.001). Conclusions: This is the largest series of treated RSV cases after LTX and the first to show that IV ribavirin and oral corticosteroids is well tolerated and effective in reducing RSV related complications after LTX. Cost-utility is established versus nebulised therapy. Early diagnosis and management are integral to the efficacy of treatment to prevent severe airway epithelial injury and the sequelae of BOS.

Hepatitis B and C serologic profiles of Canadian organ donors and recipients: retrospective 10‐year review at a single center

“…Only 10.8% and 18.7% of adult cardiothoracic and liver transplant recipients had HBV vaccine immunity. It is well recognized that the HBV vaccine is less effective in patients with end‐organ failure, but strategies including double‐strength dosing, and monitoring of serologic response to vaccine, with repeat immunization for initial non‐responders, have achieved seroconversion rates of up to 50% in pre‐cardiac and 37% in pre‐liver transplant adult recipients . In the pediatric population, cardiothoracic recipients were least likely to have HBV vaccine immunity, which may reflect their very young age at transplantation and a general hesitancy by the primary care teams to immunize critically ill infants.…”

Hepatitis B core antibody‐positive donors in cardiac transplantation: a single‐center experience

“…Available data suggest that the response to primary HBV vaccination may indeed be lower in patients with advanced heart failure in the pre‐transplant period , and that the overall immunogenicity of post‐transplantation HBV vaccination is poor, particularly in the early post‐transplant period . The absence of serologic evidence of immunity (e.g., detectable HBsAb) in 94% of recipients pre‐transplantation was notable, as HBsAb may afford significant protection in the peri‐ and post‐transplant period.…”

Influence of HBcAb positivity in the organ donor in heart transplantation

“…There is unanimous agreement on the advisability of vaccinating patients on the transplant waiting list against hepatitis B, 10,12,26 though as we have seen, this criterion is not followed by all the transplantation units. Vaccination does not guarantee immunization, since the immune response tends to be impaired in patients with chronic illnesses or in critical condition 26 ; quantitation of the HBsAb titers is therefore advisable. Madayag et al recommend that patients on the renal transplant waiting list should not receive organs from HBcAb (+) donors if they present HBsAb titers of <100 IU/l.…”

“…3,14,16 Probably, with the low risk of transmission of the infection through the heart, HBsAb titers of >10 IU/l can prove protective against the infection. 26 In some cases, the patient either has not been vaccinated, or there has not been or there is not enough time to complete the recommended vaccination period. These patients could receive an organ from an HBcAb (+) donor, provided drug prophylactic measures are also adopted.…”