Immunity to Vaccine-preventable Viral Infections in Australians Being Evaluated for Liver Transplantation

Abstract

Background. Vaccine-preventable viral infections are associated with increased risk of morbidity and mortality in immunocompromised patients. Current guidelines recommend routine screening and vaccination of all patients before solid organ transplantation. We studied rates of immunity against vaccine-preventable viruses in liver transplantation (LT) recipients. Methods. We retrospectively studied consecutive adult patients who underwent first deceased donor LT at a single center between August 2008 and October 2017. Viruses studied were hepatitis A (HAV), hepatitis B (HBV), varicella zoster virus (VZV), measles, and mumps. Hepatitis B surface antibody (anti-HBs) <10 IU/mL in HBV surface antigen-negative patients and negative IgG to other viruses was regarded as absent immunity. Results. Five hundred and fifty-five patients underwent LT (72.4% male; median age, 55.0 y). Percentages of patients who lacked immunity to vaccine-preventable infections were HAV (31.8%), HBV (63.8%), measles (1.4%), mumps (6.6%), and VZV (3.8%). Age was positively associated with immunity (from either past exposure or vaccination) against most viruses, including HAV, measles, mumps, and VZV (P < 0.05 for all). In contrast, older age was marginally associated with anti-HBs <10 IU/mL (P = 0.046). No significant changes in immunity rates were observed during the study period. Conclusions. A substantial number of patients undergoing LT are not immune to vaccine-preventable viruses at the time of assessment. This presents an opportunity for pre-LT vaccination and in particular younger patients may need to be targeted.

Immunity to varicella, measles, and mumps in patients evaluated for lung transplantation

“…While previous studies have focused on vaccine‐preventable titers in the liver and kidney transplant populations, pre‐transplant data in LTx candidates have been sparse and lacking. For example, Gardiner et al studied ~500 liver transplant candidates and called attention to the rates of undetectable titers to live vaccines in solid organ transplant candidates 2 . Similar to our study, the younger patients in this prior cohort tended to have higher rates of undetectable titers raising concern over lack of sustained response to childhood vaccine series in those with concomitant illnesses or perhaps differences in age‐related vaccines practices or exposures.…”

“…Vaccine titers may also wane more quickly in advanced end‐organ disease leaving a patient susceptible to infection. Consistent with this idea, a retrospective study of over 500 liver transplant candidates demonstrated 1.4%, 6.6%, and 3.8% lacked immunity to measles, mumps and VZV, respectively 2 . Such data are of particular concern in view of the 2019 CDC findings indicating the largest number of cases of measles reported in the United States since 1994 3 .…”

New blood‐borne virus infections among organ transplant recipients: An Australian data‐linked cohort study examining donor transmissions and other HIV, hepatitis C and hepatitis B notifications, 2000‐2015

“…First, national and international guidelines recommend all transplant recipients should be vaccinated for HBV at wait‐listing 26,27 . Immunity from vaccination can prevent new infection, although vaccination response rates can be poor in organ failure and adherence to guidelines may be incomplete 41 . Second, where new viral infection occurs, this can now be treated.…”

Italian association for the study of the liver position statement on SARS-CoV2 vaccination

“…Therefore, it is highly recommended to vaccinate patients prior to transplantation, especially at early stages (a less decompensated disease with a lower score of the model for end-stage liver disease) to avoid any influence of the end-organ disease on the immunogenicity of the vaccine. The rates of immunity against vaccinepreventable viruses in the adult patients undergoing liver transplantation have not been studied extensively [16] and the optimal time for post-transplantation vaccine administration remains unknown. Most centers commence the vaccinations approximately 3-6 months after the transplantation as by then the baseline immunosuppression levels have been reached.…”