HBV vaccination status in patients with end stage pulmonary disease evaluated for lung transplantation

Background: In times of limited donor resources, anti-HBc positive organs can be accepted for lung transplantation in order to increase the number of donors. Transplant recipients should be vaccinated against hepatitis B during transplant evaluation to prevent HBV infection. However, response after HBV vaccination has not been evaluated in patients with end stage pulmonary disease.

Methods: Anti-HBs titers of anti-HBc negative patients with end stage pulmonary disease evaluated for lung transplantation were analyzed with the Architect® system (Abbott, Germany). Responders, partial responders, or non-responders after HBV vaccination were defined by anti-HBs titres > 100 IU/L, 10 – 100 IU/L, and < 10 IU/L, respectively.

Results: 22 patients were analyzed (50% female, age 59.2 ± 4.5 years) and vaccinated either with Engerix® or Twinrix®. Three and more or two vaccinations were performed in 12 (54%) and six (27%) of cases. Four individuals (18%) were not vaccinated. Response, partial response, and non-response after vaccination were observed in 6/18 (33%), 5/18 (28%), and 7/18 (39%) of patients, respectively. Individuals with three or more vaccinations did not develop anti-HBs titres > 100 IU/L more frequently than patients with two vaccinations (n= 4/12 vs. n= 2/6).

Discussion: Only 6/22 (27%) of patients evaluated for lung transplantation showed anti-HBs titres > 100 IU/L. Thus, in case of transplantation of an anti-HBc positive donor organ, the majority of recipients needs therapy with a nucleos(t)ide analogue to prevent HBV reactivation after surgery.