Hepatitis A antibodies in liver transplant recipients: Evidence for loss of immunity posttransplantation

Liver transplant recipients frequently have chronic liver diseases and shou ld be considered for vaccination against hepatitis A virus (HAV). However, persistence of protective antibodies after orthotopic liver transplantation (OLT) has not been shown in this population, which may have implications f or future vaccine recommendations. We evaluated the prevalence and epidemio logical significance of immunoglobulin G (IgG) antibody to HAV (anti-HAV) i n a nonvaccinated population before OLT (immunity from previous exposure) a nd determined the persistence of IgG anti-HAV at 1 and 2 years after OLT, O ne hundred consecutive patients were identified who underwent OLT and had a t least 2 years of follow-up post-OLT, They were not vaccinated against HAV infection at any time, Clinical data were summarized from medical records, and stored sera were tested for IgG anti-HAV before OLT and at 1 and 2 yea rs after OLT by a commercially available enzyme immunoassay, Of 100 patient s, 24 had IgG anti-HAV before OLT. No epidemiological differences were note d between those with or without detectable IgG anti-HAV before OLT. Among p atients with detectable IgG anti-HAV before OLT, 4 of 22 patients (18%) and 7 of 24 patients (29%) became negative for IgG anti-HAV at 1 and 2 years p ost-OLT, respectively, None of the patients with undetectable IgG anti-HAV before OLT became positive at any time. Most of our patients with end-stage liver disease had no serological evidence for immunity against HAV.A signi ficant proportion of patients with detectable protective antibodies before OLT lost their antibodies at 2 years after OLT. Copyright (C) 2000 by the A merican Association for the Study of Liver Diseases.