Vaccination against hepatitis A virus (HAV) and hepatitis B virus (HBV) is generally recommended for patients with chronic
liver disease and those evaluated for
liver transplantation in the absence of immunity. HAV and HBV
infections after
liver transplantation are frequent and associated with a worse prognosis. The data suggest that the number of patients with chronic
liver disease without naturally acquired immunity against HAV and HBV is substantial, and that new vaccination strategies are needed. The aim of this study was to determine the level of immunity from
hepatitis A and B
infections and the need for HBV and HAV vaccination among cirrhotic patients evaluated for
liver transplantation. We studied HBV and HAV serological markers (
HbsAg, anti-HBc, anti-HBs,
IgG anti-HAV) in 451 cirrhotic patients evaluated for
liver transplantation to investigate the association with gender, age, and etiology of
cirrhosis. Negative HBV markers were observed in 57% of patients with 43% displaying one positive HBV marker:
HBsAg (+), 9.5%; anti-HBc (+)/anti-HBs (-), 11.5%; anti-HBc (-)/anti-HBs(+), 4.2%; anti-HBc(+)/anti-HBs(+), 17.7%. HBV
vaccine indication established in 68.5% of patients was greater among women and hepatitis C virus-negative patients. No differences were observed in age or cause of
cirrhosis. HAV vaccination indicated in 6.7% of patients (
IgG anti-HVA-negative) was greater among patients with negative HBV markers (9.3% vs 3.3%, P = .018) and younger patients (25.3% of patients </=45 years). In conclusion, there are frequent indication, for HBV
vaccine among cirrhotic patients evaluated for
liver transplantation, as is time for HAV
vaccine, especially among patients younger than 45 years of age.