Post-vaccination hepatitis B seroprotection among kidney transplant recipients in Saudi Arabia: a retrospective cohort study
DOI:
https://doi.org/10.18203/2320-6012.ijrms20262796Keywords:
Hepatitis B vaccination, Seroprotection, Kidney transplantation, Anti-HBs antibodies, Vaccine nonresponseAbstract
Background: Evidence regarding post-vaccination hepatitis B virus (HBV) seroprotection among kidney transplant recipients in Saudi Arabia remains limited. This study estimated the prevalence of seroprotection and evaluated factors associated with vaccine nonresponse.
Methods: This single-center retrospective cohort study included adult kidney transplant recipients followed at Prince Sultan Military Medical City, Riyadh, Saudi Arabia, who had documented hepatitis B vaccination and subsequent quantitative measurement of antibodies to hepatitis B surface antigen (anti-HBs). Seroprotection was defined as an anti-HBs concentration of at least 10 mIU/ml. Participant characteristics were compared according to seroprotection status. Multivariable logistic regression was used to evaluate associations between non-seroprotection and total number of hepatitis B vaccine doses.
Results: Among 100 kidney transplant recipients, the mean (SD) age was 41.4 (15.2) years, and 66 participants (66.0%) were male. Overall, 69 recipients achieved seroprotection (69.0%; 95% CI, 59.4-77.2%), whereas 31 (31.0%) remained non-seroprotected. Vaccine dose category differed significantly by seroprotection status (p=0.014); 80.6% of non-seroprotected recipients had received only 1 to 2 doses compared with 50.7% of seroprotected recipients. In the adjusted model, no variable was independently associated with non-seroprotection. Each 10-year increase in age was associated with higher, but not statistically significant, odds of non-seroprotection (aOR, 1.44; 95% CI, 0.96-2.16; p=0.079).
Conclusions: Nearly one-third of vaccinated kidney transplant recipients lacked serological protection against HBV. Routine post-vaccination anti-HBs testing and individualized booster or revaccination strategies should be considered, particularly for older recipients and those who have received fewer vaccine doses.
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References
World Health Organization. Global hepatitis report 2024: action for access in low- and middle-income countries. 2024. Available at: https://www.who.int/publications/i/item/9789240091672. Accessed on 15 May 2026.
Alghamdi IG, Alghamdi RM, Alghamdi MS, Alghamdi AM, Alghamdi MI, Alghamdi ZI, et al. Epidemiology of hepatitis B in Saudi Arabia from 2006 to 2021. Hepat Med. 2023;15:233-47. DOI: https://doi.org/10.2147/HMER.S438099
Abdo AA, Sanai FM, Al-Faleh FZ. Epidemiology of viral hepatitis in Saudi Arabia: are we off the hook? Saudi J Gastroenterol. 2012;18:349-57. DOI: https://doi.org/10.4103/1319-3767.103425
Chancharoenthana W, Traitanon O, Leelahavanichkul A, Ronco C. Optimizing hepatitis B vaccination in chronic kidney disease: a comprehensive scoping review of strategies across CKD stages, dialysis, and transplant populations. Ren Fail. 2025;47:2541873. DOI: https://doi.org/10.1080/0886022X.2025.2541873
Kidney Disease: Improving Global Outcomes Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant 2009;9(3):S1-155. DOI: https://doi.org/10.1111/j.1600-6143.2009.02834.x
Dadhania DM, Cravedi P, Blumberg E, Stryniak G, Montez-Rath ME, Maltzman JS. Age-related decline in anti-HBV antibodies in vaccinated kidney transplant recipients. Transpl Infect Dis. 2023;25:e14090. DOI: https://doi.org/10.1111/tid.14090
Yin S, Zhang F, Wu J, Lin T, Wang X. Incidence, risk factors, and clinical outcomes of HBV reactivation in non-liver solid organ transplant recipients with resolved HBV infection: a systematic review and meta-analysis. PLoS Med. 2023;20:e1004196. DOI: https://doi.org/10.1371/journal.pmed.1004196
Chen J, Wu B, Chen J, Chu Q. Incidence and risk factors for hepatitis B virus reactivation in kidney transplant recipients: a systematic review and meta-analysis. BMC Nephrol. 2026;27:325. DOI: https://doi.org/10.1186/s12882-026-04967-1
Schillie S, Vellozzi C, Reingold A, Harris AM, Haber P, Ward JW, et al. Prevention of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2018;67:1-31. DOI: https://doi.org/10.15585/mmwr.rr6701a1
World Health Organization. Consolidated guidelines on hepatitis B and C prevention, testing, treatment, service delivery and monitoring: an implementation handbook for a public health approach. 2026. Available at: https://www.who.int/publications/i/item/9789240119529. Accessed on 15 May 2026.
Al Saran K, Sabry A, Al Halawany Z, Ismail M. Factors affecting response to hepatitis B vaccine among hemodialysis patients in a large Saudi hemodialysis center. Saudi J Kidney Dis Transpl. 2014;25:185-91. DOI: https://doi.org/10.4103/1319-2442.124572
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology statement: guidelines for reporting observational studies. Lancet. 2007;370:1453-7. DOI: https://doi.org/10.1016/S0140-6736(07)61602-X
Benchimol EI, Smeeth L, Guttmann A, Harron K, Moher D, Petersen I, et al. The REporting of studies Conducted using Observational Routinely-collected health Data statement. PLoS Med. 2015;12:e1001885. DOI: https://doi.org/10.1371/journal.pmed.1001885
Lau G, Yu ML, Wong G, Thompson A, Ghazinian H, Hou JL, et al. APASL clinical practice guideline on hepatitis B reactivation related to the use of immunosuppressive therapy. Hepatol Int. 2021;15:1031-48. DOI: https://doi.org/10.1007/s12072-021-10239-x
Weng MK, Doshani M, Khan MA, Frey S, Ault K, Moore KL, et al. Universal hepatitis B vaccination in adults aged 19-59 years: updated recommendations of the Advisory Committee on Immunization Practices—United States, 2022. MMWR Morb Mortal Wkly Rep. 2022;71:477-83. DOI: https://doi.org/10.15585/mmwr.mm7113a1
Conners EE, Panagiotakopoulos L, Hofmeister MG, Spradling PR, Hagan LM, Harris AM, et al. Screening and testing for hepatitis B virus infection: CDC recommendations—United States, 2023. MMWR Recomm Rep. 2023;72:1-25. DOI: https://doi.org/10.15585/mmwr.rr7201a1
Altman DG, Royston P. The cost of dichotomising continuous variables. BMJ. 2006;332:1080. DOI: https://doi.org/10.1136/bmj.332.7549.1080
Firth D. Bias reduction of maximum likelihood estimates. Biometrika. 1993;80:27-38. DOI: https://doi.org/10.1093/biomet/80.1.27
Heinze G, Schemper M. A solution to the problem of separation in logistic regression. Stat Med. 2002;21:2409-19. DOI: https://doi.org/10.1002/sim.1047
Brown LD, Cai TT, DasGupta A. Interval estimation for a binomial proportion. Stat Sci. 2001;16:101-33. DOI: https://doi.org/10.1214/ss/1009213286
Harrell FE Jr. Regression modeling strategies: with applications to linear models, logistic regression, and survival analysis. New York, NY: Springer; 2001. DOI: https://doi.org/10.1007/978-1-4757-3462-1
Christodoulou E, Ma J, Collins GS, Steyerberg EW, Verbakel JY, Van Calster B. A systematic review shows no performance benefit of machine learning over logistic regression for clinical prediction models. J Clin Epidemiol. 2019;110:12-22. DOI: https://doi.org/10.1016/j.jclinepi.2019.02.004
Jain SR, Kumar D. Vaccination for the post-kidney transplant population. Curr Opin Nephrol Hypertens. 2019;28:581-6. DOI: https://doi.org/10.1097/MNH.0000000000000546
Chiu CY, Sampathkumar P, Brumble LM, Vikram HR, Watt KD, Beam E. Optimizing hepatitis B virus seroprotection in thoracic organ transplantation: the role of the HepB-CpG vaccination schedule. Vaccine. 2025;47:126705. DOI: https://doi.org/10.1016/j.vaccine.2025.126705
Chiu CY, Sampathkumar P, Brumble LM, Vikram HR, Watt KD, Beam E. Hepatitis B vaccine compliance, serologic response, and durability in adult thoracic organ transplant recipients. Clin Transplant. 2024;38:e15464. DOI: https://doi.org/10.1111/ctr.15464
Velikova T, Gerasoudis S, Batselova H. Vaccination for solid organ transplanted patients: recommendations, efficacy, and safety. World J Transplant. 2024;14:92172. DOI: https://doi.org/10.5500/wjt.v14.i4.92172
Waller KMJ, De La Mata N, Hedley JA, Sharma T, Davies R, Garrett E, et al. Transmission risk of intentional transplantation of kidneys from donors with active hepatitis B to recipients without active hepatitis B: a systematic review and meta-analysis. Transplantation. 2026;110:e912-22. DOI: https://doi.org/10.1097/TP.0000000000005575
Iwata K, Ikegaki S, Hyodo Y, Miyake H. Hepatitis B boosters using a different product versus the same product for kidney transplant recipients: a retrospective study with Bayesian inference. Clin Transplant. 2025;39:e70307. DOI: https://doi.org/10.1111/ctr.70307
Chancharoenthana W, Leelahavanichkul A, Udomkarnjananun S, Wattanatorn S, Avihingsanon Y, Praditpornsilpa K, et al. Durability of antibody response against the hepatitis B virus in kidney transplant recipients: a proposed immunization guideline from a 3-year follow-up clinical study. Open Forum Infect Dis. 2019;6:ofy342. DOI: https://doi.org/10.1093/ofid/ofy342
Yin S, Chen X, Li X, Zhang F, Wu J, Lin T. Was antiviral prophylaxis necessary after kidney transplantation utilizing anti-HBc-positive donors? A systematic review and meta-analysis. Transplant Rev (Orlando). 2024;38:100840. DOI: https://doi.org/10.1016/j.trre.2024.100840
Paschereit A, Greese V, Sakurayama K, Duerr M, Halleck F, Liefeldt L, et al. Impact of hepatitis B infection on patient and graft survival after kidney transplantation. J Clin Med. 2025;14:2124. DOI: https://doi.org/10.3390/jcm14062124
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