4 in 10 liver transplant recipients aren’t vaccinated against hepatitis B, researchers report
Mary Van Beusekom, MSToday at 3:44 p.m.
Hepatitis
Yesterday in Clinical Infectious Diseases, a team led by Baylor College of Medicine researchers revealed that only 60% of liver transplant (LT) recipients are vaccinated against hepatitis B virus (HBV), putting them at risk for severe complications.
The authors analyzed data on deceased-donor LT recipients from September 2022 to June 2024 from the United Network for Organ Sharing (UNOS), which in 2021 began requiring all LT programs to report HBV antibody levels and vaccination of LT recipients before transplant.
“Current clinical guidelines emphasize systematic HBV testing and vaccination of eligible LT candidates, in parallel with universal donor screening, to reduce the risk of unintended viral transmission and de novo infection,” the researchers wrote.
Older age, liver disease tied to lower odds of vaccination
Of the 13,851 LT recipients, 8,295 (60%) were considered vaccinated based on self-reported HBV vaccine receipt or evidence of HBV antibodies.A multivariable analysis showed that several factors were tied to a slightly higher odds of HBV vaccination, including female sex (adjusted odds ratio [aOR], 1.05), Black race (aOR, 1.08), hepatocellular carcinoma (HCC) diagnosis (aOR, 1.06), attainment of a bachelor’s degrees or higher (aOR, 1.09), and waitlist time longer than 6 months (aOR, 1.06).
Risk factors for not getting vaccinated were older age (50 to 64 years aOR, 0.88; 65 to 89 aOR, 0.86), alcohol-associated liver disease (ALD; aOR, 0.93), other liver diseases (aOR, 0.90), Model for End-Stage Liver Disease–Sodium (MELD-Na) score of 30 or higher (aOR, 0.91), and less than a high school education (aOR, 0.93).
Relative to LT recipients in UNOS region 9 (New York and Vermont), those in regions 1 (Connecticut, Maine, Massachusetts, New Hampshire, and Rhode Island), 5 (Arizona, California, Nevada, New Mexico, and Utah), 6 (Alaska, Hawaii, Idaho, Montana, Oregon, and Washington), 7 (Illinois, Minnesota, North Dakota, South Dakota, and Wisconsin), 10 (Indiana, Ohio, and Michigan), and 11 (Kentucky, North Carolina, South Carolina, Tennessee, and Virginia) were more likely to be vaccinated against HBV.
In contrast, LT recipients in regions 2 (Delaware, District of Columbia, Maryland, New Jersey, Pennsylvania, New Jersey, and West Virginia), 3 (Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, and Puerto Rico), and 4 (Oklahoma and Texas) had lower odds of HBV vaccination.
“This is consistent with regional trends in vaccination rates of tetanus-diphtheria-acellular pertussis, herpes zoster, and pneumococcus, which suggests that regional factors such as local vaccine policies and social trends, attitudes, and beliefs about vaccines may play an important role,” the authors wrote.
Accelerated vaccination strategies
The findings, the researchers said, highlight the importance of developing educational materials and policies that address differences in health literacy, informed by local social and cultural contexts, to improve vaccine uptake.A concerning finding, they said, is that LT candidates diagnosed as having ALD and those with shorter waitlist times were less likely to be vaccinated, given that LT waitlist times have become shorter and ALD is now the most common reason for LT in the United States.
“While this may partly reflect the time required to complete the HBV vaccine series, it also likely reflects clinical practice patterns: patients with ALD or more severe liver disease often have shorter waitlist times and may miss opportunities for vaccination,” they wrote. “These findings support consideration of accelerated vaccination strategies in LT candidates.”
Interventions such as patient reminders and recalls can improve vaccine receipt, as can computer-based, nurse-driven protocols and embedding a structured infectious disease evaluation into LT workup, the authors noted.
“Target interventions should focus on older adults, patients with ALD, and higher MELD-Na, while also addressing regional and educational disparities,” they concluded. “Further research is needed to understand how sex, race, region of residence, education, and other social determinants of health influence HBV vaccination with an intersectionality framework.”