Hepatitis B in transplant recipients: an Australian single-centre study of screening, vaccination and management.

Background: There are limited existing data regarding the quality of hepatitis B (HepB) screening or management among transplant recipients who are at increased risk of donor-derived HepB infection.

Aims: This study examined: (i) the rate of appropriate HepB screening prior to transplant, (ii) the rate of completion of the HepB course for those who required vaccination and (iii) the management of transplant recipients at risk of HepB-related adverse outcomes in our cohort, including the rate of HepB flare or reactivation.

Methods: We performed a retrospective analysis of 400 transplant recipients (200 solid organ and 200 haemopoietic stem cell transplant recipients) from January 2020 to December 2021 at Alfred Health, Melbourne, Australia. Key information about HepB screening and vaccination was extracted from medical records. Progress notes were examined to assess the management of any HepB-related adverse events.

Results: The pre-transplant HepB screening rate was 99.25%. Among those with vaccination records, 59.8% completed a HepB vaccination course. We observed variation in the duration of nucleoside analogue use as chemoprophylaxis among individuals with resolved HepB, ranging from 3 months to lifelong. HepB reactivation occurred in one recipient with prior resolved HepB during the study. The prevalence of chronic HepB was 0.75%, with all cases appropriately managed.

Conclusion: Vaccination rates exceeded some international reports but fell short of recommendations. Lack of centralised vaccination records likely adversely impacted vaccination rates. Mechanisms to streamline HepB screening, vaccination and management peri-transplant should be explored to improve outcomes for this vulnerable cohort.