Hepatitis B Vaccination Confers an Increased Rate of Transplant for Patients on the Heart Transplant Waiting List

Currently, donors that are hepatitis B core antibody positive are not accepted by patients awaiting heart transplant unless the recipient has been vaccinated for hepatitis B, and thus has positive surface antibodies. For those heart failure patients awaiting heart transplant who have been vaccinated for hepatitis B, there is a greater likelihood of them being transplanted as there would be less competition for these hepatitis B core antibody positive donor hearts. Current policy in the United States does not mandate that all patients awaiting heart transplant receive hepatitis B vaccine. We sought to assess the effect of hepatitis B vaccination on patients who are awaiting heart transplant. Between 2010 and 2012, we evaluated 277 patients on the heart transplant waiting list, and divided them into groups depending on whether they were hepatitis B surface antibody positive pre-transplant. Of the 277 patients, 76 patients were hepatitis B surface antibody positive and 201 patients were not. The percentage transplanted in each group was then compared. To assess the safety of using hepatitis B donor hearts, both groups were assessed for 1 year survival year survival, freedom from rejection, freedom from infection, and freedom from abnormal liver function tests (defined as >2 times upper limit normal). Those patients who were hepatitis B surface antibody positive were transplanted at a higher rate compared to those who were hepatitis B surface antibody negative (91% vs 77%, p<0.01). There was no significant difference between both groups in post-transplant one year survival, freedom from rejection, freedom from infection, and freedom from abnormal liver function tests (see table). Patients awaiting heart transplant who are hepatitis B surface antibody positive appear to have an advantage in receiving a heart transplant compared to those who do not.TableReceived Hep B + Donor (n=12)Received Hep B - Donor (n=211)P value1-Year Survival83%94%0.091-Year Freedom from Any Rejection86%83%0.691-Year Freedom from Infection83%62%0.181-Year Freedom from Abnormal LFTs99%97%0.45 Open table in a new tab