High prevalence of hepatitis B nonimmunity in vaccinated pediatric liver transplant recipients

Am J Transplant. 2015 Feb;15(2):535-40. doi: 10.1111/ajt.12987. Epub 2015 Jan 21.


Durable protection from hepatitis B virus (HBV) and other vaccine-preventable diseases assumes great importance due to improved long-term patient and graft survival rates in pediatric liver transplantation. Vaccine immunogenicity data in transplanted children is limited. This was a cross-sectional, single-center, point-prevalence study evaluating HBV immunity in 160 pediatric liver transplant recipients. Patients with hepatitis B surface antibody levels <10 IU/L were considered nonimmune. Predictor variables for nonimmunity identified in univariate analyses were later analyzed within a logistic regression model. All subjects received the full HBV vaccination series prior to transplant. The majority (67%) of previously immunized pediatric liver transplant patients were nonimmune. Older children (p < 0.001) and children who were further out from transplant (p < 0.001) were more likely to be nonimmune in univariate analyses, but only time from transplant was a significant predictor of nonimmunity in a logistic regression model (odds ratio 1.3, p < 0.001 at 1 year). The mean time since transplant was 5.6 years ± 4.6. Markers of nutrition, immunosuppression, white blood cell parameters and type/severity of disease did not correlate with HBV immunity. Information on the anamnestic response to boosting or revaccination is needed to adequately address this vulnerable group.

Keywords: Clinical research/practice; infection and infectious agents; infectious disease; liver disease: infectious; liver transplantation/hepatology; pediatrics; preventive healthcare; viral: hepatitis B.

MeSH terms

  • Age Factors
  • Antibodies / blood
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Female
  • Hepatitis B / epidemiology*
  • Hepatitis B / immunology
  • Hepatitis B / prevention & control*
  • Hepatitis B Surface Antigens / immunology
  • Hepatitis B Vaccines / immunology*
  • Hepatitis B Vaccines / therapeutic use*
  • Hepatitis B virus / immunology*
  • Hepatitis B virus / isolation & purification
  • Humans
  • Liver / pathology
  • Liver / virology
  • Liver Transplantation*
  • Logistic Models
  • Male
  • Prevalence
  • Risk Factors
  • Severity of Illness Index
  • Time Factors
  • Transplant Recipients*
  • United States


  • Antibodies
  • Hepatitis B Surface Antigens
  • Hepatitis B Vaccines