IDDF2021-ABS-0203 A screening model for obstructive sleep apnea on the basis of fatty liver disease-related parameters

Abstract

Methods A cross-sectional study of all eligible LT recipients from 2008 to 2020 in a leading transplant centre in Singapore was conducted to determine the vaccine response in HBV-naïve subjects. A standardised workflow was devised to identify barriers in vaccination and response monitoring. Transplant coordinators and pharmacists assisted physicians to identify and prescribe CDC-recommended vaccinations using a template, which include Engerix 40mcg of three doses, followed by rechecking anti-HBs titre one month after. A second 3-dose Engerix regimen was given if anti-HBs remains <10 mIU/mL. Non-responder is defined as failure to achieve protective anti-HBs titre after completing two cycles. Results Of the 279 LT recipients, we excluded patients not on follow-up and patients with anti-HBc positivity. 75 patients were included. Prior to vaccination implementation, 9/75 (12%) were not checked for anti-HBs. Of the 66 checked, 40 required vaccination. 29/40 (72.5%) were started on the first cycle, and 21/40 (52.5%) completed. 11/20 (55%) patients were initiated on the second cycle. Post workflow implementation, 40 needed vaccination. 34/40 (85%) were started on the first cycle and 24/40 (60%) completed. 18/23 (78.3%) were started on a second cycle. 3/4 (75%) were non-responders (IDDF2021-ABS-0190 Figure 1). Our implementation coincided with the COVID-19 pandemic where more teleconsultation was used. COVID-19 vaccination was also prioritised over HBV vaccination. We postulate that these results would be further improved once physical consultations resumed. Conclusions The development of a standardised workflow can lead to improvement in anti-HBs testing and compliance to vaccination post-LT. These findings may be useful for other patients who are on long-term immunosuppression. Continual efforts from the multidisciplinary team are required to ensure the sustainability of effect.