Hepatitis A antibodies in liver transplant recipients: Evidence for loss of immunity posttransplantation

Abstract

Liver transplant recipients frequently have chronic liver diseases and should be considered for vaccination against hepatitis A virus (HAV). However, persistence of protective antibodies after orthotopic liver transplantation (OLT) has not been shown in this population, which may have implications for future vaccine recommendations. We evaluated the prevalence and epidemiological significance of immunoglobulin G (IgG) antibody to HAV (anti-HAV) in a nonvaccinated population before OLT (immunity from previous exposure) and determined the persistence of IgG anti-HAV at 1 and 2 years after OLT. One hundred consecutive patients were identified who underwent OLT and had at least 2 years of follow-up post-OLT. They were not vaccinated against HAV infection at any time. Clinical data were summarized from medical records, and stored sera were tested for IgG anti-HAV before OLT and at 1 and 2 years after OLT by a commercially available enzyme immunoassay. Of 100 patients, 24 had IgG anti-HAV before OLT. No epidemiological differences were noted between those with or without detectable IgG anti-HAV before OLT. Among patients with detectable IgG anti-HAV before OLT, 4 of 22 patients (18%) and 7 of 24 patients (29%) became negative for IgG anti-HAV at 1 and 2 years post-OLT, respectively. None of the patients with undetectable IgG anti-HAV before OLT became positive at any time. Most of our patients with end-stage liver disease had no serological evidence for immunity against HAV. A significant proportion of patients with detectable protective antibodies before OLT lost their antibodies at 2 years after OLT.

Transmission of Hepatitis A Virus through Combined Liver–Small Intestine–Pancreas Transplantation

“…Because of the acute nature of HAV infection, pretransplant testing is not routinely done, although hepatitis A vaccination of transplantation candidates is recommended ( 16 ). The multi–visceral organ recipient was vaccinated, but studies have shown loss of immunity to HAV after transplantation because of immunosuppression ( 19 , 20 ). The heart and kidney transplant recipients had evidence of immunity and probably were protected through previous vaccination.…”

A randomized controlled trial of comparative effectiveness between the 2 dose and 3 dose regimens of hepatitis a vaccine in kidney transplant recipients

“…Moreover, the seroprevalence in each geographic area may also affect the seroconversion rate after hepatitis A vaccination. In a previous study, 18% and 29% of the patients with positive pre-transplant anti-HAV had lost their immunity 1 and 2 years after transplant, respectively 16 . Therefore, post-transplant vaccination probably acts as a booster dose and yields a higher chance of seroconversion among these patients 26 .…”

“…According to the guidelines, hepatitis A vaccine should be given to either SOT candidates or recipients who have negative anti-HAV immunoglobulin G (IgG) 13,14 . However, there were scarce data on anti-HAV seroprevalence of standard 2-dose regimen in SOT and the results varied between countries [15][16][17] .…”

In-hospital post-transplant acute hepatitis A viral (HAV) infection in a liver transplant recipient who was HAV seropositive pre-transplant

“…This was reported in a retrospective study where 18% and 29% of patients with previously detectable anti-HAV IgG from natural infection became anti-HAV IgG non-detectable at 1 and 2 years post transplant. [13] Anti-HAV IgG antibody loss may be caused by strong anti-rejection regimens given following liver transplant (LT). These immune-suppressing medications, including high-dose systemic steroids and mycophenolate mofetil, may decimate some memory B-cell pools.…”