Division of Public Health, Infectious Diseases, and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Department of Medicine, Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado, USA.
Clin Transplant. 2024 Sep;38(9):e15464. doi: 10.1111/ctr.15464.
Hepatitis B virus (HBV) vaccination is recommended for solid organ transplant (SOT) candidates. However, there is a lack of data on the HBV vaccine compliance, serologic response, and durability of HBV seroprotection in thoracic organ transplantation recipients.
We conducted a retrospective study of adult thoracic organ (heart and lung) transplant candidates who received HBV vaccination at Mayo Clinic sites in Minnesota, Arizona, and Florida between January 2018 and August 2023. Conventional recombinant hepatitis B vaccine (Recombivax HB) was used before 2020, and Heplisav-B was preferred after 2020. HBV seroprotection was defined as hepatitis B surface antibody (HBsAb) ≥ 10 IU/L. Furthermore, we compared characteristics between recipients who maintained HBV seroprotection and those who lost HBV seroprotection (HBsAb < 10 IU/L) at 30 days posttransplantation (D30).
Among 922 candidates who were eligible for HBV vaccination, 430 (47%) completed the HBV vaccine series. Patients receiving Heplisav-B were more likely to complete the series than Recombivax HB (81% vs. 60%, p < 0.001) and Heplisav-B had a higher seroprotection rate than Recombivax HB (75% vs. 64%, p = 0.023). Multivariate logistic regression analysis identified receiving Heplisav-B as an independent predictor for HBV seroprotection (adjusted odds ratio [aOR] 1.723; 95% confidence interval [CI] 1.056-2.810; p = 0.029). A total of 145 thoracic organ transplant recipients achieved HBV seroprotection at the date of transplantation. Loss of HBV seroprotection occurred in 38 (26%) patients at D30. Multivariate logistic regression analysis identified two predictors for HBV seroprotection loss at D30: age ≥ 60 years (aOR, 2.503; 95% CI 1.026-6.107; p = 0.044), and pretransplant HBsAb level between 10 and 100 IU/L (aOR, 18.575; 95% CI 5.211-66.209; p < 0.001).
Although less than half of thoracic organ transplant candidates completed HBV vaccine series pretransplant, Heplisav-B provided a higher vaccine completion rate and seroprotection than the 3-dose Recombivax HB. Clinicians should also be aware of the increased loss of HBV seroprotection in thoracic organ transplant recipients with age ≥ 60 years and pretransplant HBsAb between 10 and 100 IU/L. Assessment of seroprotection after HBV vaccination should be prioritized during the pretransplant period.
乙型肝炎病毒 (HBV) 疫苗接种被推荐用于实体器官移植 (SOT) 候选者。然而，在接受过胸器官（心脏和肺）移植的患者中，HBV 疫苗接种的依从性、血清学反应以及 HBV 血清保护的持久性方面的数据仍然缺乏。
我们对 2018 年 1 月至 2023 年 8 月期间在明尼苏达州、亚利桑那州和佛罗里达州的梅奥诊所接受 HBV 疫苗接种的成年胸器官（心脏和肺）移植候选者进行了回顾性研究。2020 年之前使用常规重组乙型肝炎疫苗（Recombivax HB），2020 年之后则优先使用 Heplisav-B。HBV 血清保护定义为乙型肝炎表面抗体 (HBsAb)≥10 IU/L。此外，我们比较了在移植后 30 天（D30）时维持 HBV 血清保护和失去 HBV 血清保护（HBsAb＜10 IU/L）的患者之间的特征。
在 922 名有资格接种 HBV 疫苗的候选者中，430 名（47%）完成了 HBV 疫苗系列接种。接受 Heplisav-B 的患者比接受 Recombivax HB 的患者更有可能完成系列接种（81%比 60%，p＜0.001），而且 Heplisav-B 的血清保护率高于 Recombivax HB（75%比 64%，p=0.023）。多变量逻辑回归分析确定接受 Heplisav-B 是 HBV 血清保护的独立预测因素（调整优势比[aOR] 1.723；95%置信区间[CI] 1.056-2.810；p=0.029）。共有 145 名胸器官移植患者在移植当天实现了 HBV 血清保护。38 名（26%）患者在 D30 时失去了 HBV 血清保护。多变量逻辑回归分析确定了 D30 时 HBV 血清保护丧失的两个预测因素：年龄≥60 岁（aOR，2.503；95%CI 1.026-6.107；p=0.044）和移植前 HBsAb 水平在 10 至 100 IU/L 之间（aOR，18.575；95%CI 5.211-66.209；p＜0.001）。
尽管只有不到一半的胸器官移植候选者在移植前完成了 HBV 疫苗系列接种，但 Heplisav-B 提供了比 3 剂 Recombivax HB 更高的疫苗接种完成率和血清保护率。临床医生还应该注意到，年龄≥60 岁和移植前 HBsAb 水平在 10 至 100 IU/L 之间的胸器官移植患者中，HBV 血清保护的丧失增加。在移植前期间，应优先进行 HBV 疫苗接种后的血清保护评估。
