Infectious diseases pre‐transplant evaluation improves vaccination rates for liver transplant candidates

Abstract

Immunization rates in pre-liver transplant patients have been historically below rates for immunocompetent patients. At Cleveland Clinic, an infectious diseases (ID) consult is required for all patients during the liver transplant evaluation and may beneficially impact vaccination rates. The goal of this study was to evaluate pre-transplant vaccination rates in pre-liver transplant candidates. This single-center, retrospective chart review included adults transplanted between January 1, 2013, and December 31, 2016. Prior to transplant, rates of vaccination and/or documented seropositivity were 35% for hepatitis B vaccine, 92% for hepatitis A vaccine, 57% for pneumococcal conjugate vaccine, 62% for pneumococcal polysaccharide vaccine, and 77% for influenza vaccine. Vaccination rates were higher than to previously reported. Rates were also higher for several vaccines compared to transplant candidates for other organs without ID consult. With ongoing ID consult requirements for liver transplant candidates, combined with standardization of vaccine recommendations via technology, and increased multi-disciplinary collaboration, vaccination rates should improve further. K E Y W O R D Sinfectious diseases, liver transplant, vaccine

Pre‐transplant vaccination compliance in adult heart and lung transplant recipients

“…There was likely no difference observed between the heart transplant groups, because so few patients, only 9.9%, did not have an ID consult prior to transplant. These results demonstrate the positive impact of ID consult prior to transplant and are consistent with previous studies published at our institution in other cohorts including kidney, pancreas, and liver transplant recipients 4,5 …”

“…Vaccination rates and associated immunity in CC heart and lung transplant recipients are consistent with previous studies evaluating vaccination rates in kidney, kidney‐pancreas, and liver transplant recipients at our institution 4 . The observed rates of pre‐heart and lung transplant vaccination exceeded those published in prior literature 6 .…”

“…To account for missing data, we included seropositivity in addition to vaccination receipt in the definition of immunity at the time of transplantation. Previous studies included vaccination records obtained from the Ohio Department of Health vaccination registry database, ImpactSIIS https://ohioimpactsiis.org/siisprod/ which added ∼10% more to the recorded vaccination rate 4,5 . These records and records from outside healthcare facilities were not consistently obtained during our study period.…”

“…Recent respective reviews of other solid organ programs at the same institution including kidney, pancreas, and liver transplant recipients have demonstrated higher rates of vaccination in patients who had an ID consultation prior to SOT. However, opportunities to improve pre‐transplant serologic testing and vaccination remain in the population studied above 4,5 . There is a paucity of data evaluating vaccination rates and serologic status in the heart and lung transplant population suggests a similar opportunity for improvement as seen in the other SOT populations we had studied at CC 6,7 .…”

“…However, opportunities to improve pretransplant serologic testing and vaccination remain in the population studied above. 4,5 There is a paucity of data evaluating vaccination rates and serologic status in the heart and lung transplant population suggests a similar opportunity for improvement as seen in the other SOT populations we had studied at CC. 6,7 The goal of this report is to describe pre-transplant vaccination rates and serologic assessment for heart and lung transplant patients with and without an ID consult prior to listing for organ transplant.…”