成人胸腔器官移植受者接种乙型肝炎疫苗的依从性、血清反应和持久性

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2024-09-20 DOI:10.1111/ctr.15464

Chia-Yu Chiu, Priya Sampathkumar, Lisa M. Brumble, Holenarasipur R. Vikram, Kymberly D. Watt, Elena Beam

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引用次数: 0

摘要

导言：建议实体器官移植（SOT）候选者接种乙型肝炎病毒（HBV）疫苗。然而，关于胸腔器官移植受者接种 HBV 疫苗的依从性、血清反应以及 HBV 血清保护的持久性，目前还缺乏相关数据。方法我们对 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梅奥诊所接受 HBV 疫苗接种的成人胸部器官（心脏和肺）移植候选者进行了一项回顾性研究。2020 年前使用常规重组乙型肝炎疫苗（Recombivax HB），2020 年后首选 Heplisav-B。乙肝病毒血清保护定义为乙肝表面抗体（HBsAb）≥ 10 IU/L。此外，我们还比较了移植后 30 天（D30）保持 HBV 血清保护和失去 HBV 血清保护（HBsAb < 10 IU/L）的受者的特征。结果在 922 名符合 HBV 疫苗接种条件的候选者中，430 人（47%）完成了 HBV 疫苗系列接种。接种 Heplisav-B 的患者比接种 Recombivax HB 的患者更有可能完成系列接种（81% 对 60%，p < 0.001），Heplisav-B 的血清保护率比 Recombivax HB 高（75% 对 64%，p = 0.023）。多变量逻辑回归分析发现，接受 Heplisav-B 是 HBV 血清保护的独立预测因素（调整赔率比 [aOR] 1.723；95% 置信区间 [CI] 1.056-2.810；p = 0.029）。共有 145 名胸腔器官移植受者在移植当日获得了 HBV 血清保护。38名患者（26%）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 水平介于 10 和 100 IU/L 之间（aOR，18.575；95% CI 5.211-66.209；p <；0.001）。结论虽然只有不到一半的胸腔器官移植患者在移植前完成了 HBV 疫苗系列接种，但 Heplisav-B 的疫苗完成率和血清保护率均高于 3 剂 Recombivax HB。临床医生还应注意，年龄≥ 60 岁、移植前 HBsAb 在 10 至 100 IU/L 之间的胸腔器官移植受者的 HBV 血清保护丧失率会增加。在移植前应优先评估接种 HBV 疫苗后的血清保护作用。

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Hepatitis B Vaccine Compliance, Serologic Response, and Durability in Adult Thoracic Organ Transplant Recipients

Introduction

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.

Methods

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).

Results

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).

Conclusions

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.

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.