Efficacy and safety of hepatitis A vaccination in kidney transplant recipients

Background In recent years, symptomatic hepatitis A virus (HAV) infection has been reported with increasing frequency in Korea. Therefore, HAV vaccination should be considered in kidney transplant recipients (KTRs). The study investigated the efficacy and safety of HAV vaccination in KTRs under modern triple immunosuppressive agents. Methods We evaluated the seroprevalence of anti-HAV immunoglobulin-G (IgG) in KTRs who had visited the Seoul National University Hospital from March 2011 to August 2012. Seronegative patients were immunized with 2 doses of HAV vaccine at a 6-month interval. Seroconversion of anti-HAV IgG was determined 1month after the second vaccine dose, and adverse effects were monitored after each vaccination. Results Among a total 416 KTRs who were screened, 338 (81.2%) patients were seropositive for anti-HAV IgG. However, among patients who were under 40years of age, only 31.8% were seropositive. Fifty-two seronegative recipients (mean age 34.1years, 71.2% male) had received 2 doses of vaccine, and only 14 of these patients (26.9%) showed seroconversion. Vaccine responders had lower serum creatinine (1.19 +/- 0.24 vs. 1.45 +/- 0.49mg/dL, P=0.013), higher plasma hemoglobin levels (14.4 +/- 1.9 vs. 12.8 +/- 1.8g/dL, P=0.006), and had lower tacrolimus use than cyclosporine use (57.1% vs. 84.2%, P=0.040) compared with non-responders. Responders had a tendency of taking lower dose of prednisolone (3.5 +/- 1.6 vs. 4.3 +/- 1.2mg/day, P=0.076), and having fewer infection events (14.3 vs. 40.5%, P=0.076). Multivariate analysis indicated that higher hemoglobin levels and lower serum creatinine levels were significant prognostic factors for seroconversion. Overall, the vaccine was well tolerated in all patients. Conclusion HAV IgG screening is necessary for KTRs, especially young recipients. HAV vaccination was safe in KTRs; however, poor response to HAV vaccination makes it important to identify seronegative patients as early as possible and vaccinate them before end-stage renal disease occurs.