Immunoglobulin G Immunity to Hepatitis A Virus in Liver Transplant Candidates: A Serosurvey from Iran

Background: Becoming infected with hepatitis A virus (HAV) is deadlier in patients with end-stage liver disease. Objectives: This study aimed to determine the seroprevalence of chronic immunity to HAV in liver transplant (LT) candidates to determine whether HAV vaccination is necessary for them or not. Methods: This cross-sectional study was conducted on adult LT candidates who were referred to the LT center of Shiraz, Iran. The patients were interviewed for filling the data collection forms. These forms consisted of demographic information, medical backgrounds, etiology of chronic liver disease, a model for end-stage liver disease (MELD) score, laboratory findings, and abdominal sonography report. Furthermore, a 3-cc blood sample was obtained from each patient, and anti-HAV IgG was detected by Enzyme-linked Immunosorbent assay (ELISA) using standard Diapro kits. Univariable and multivariable data analyses were performed using SPSS version 20. A P-value of less than 0.05 was considered the significant cutoff in regression analysis. Results: A total of 291 patients with a mean age of 47.73 ± 12.9 years were recruited in this study of whom, 197 (67.7%) patients were males, 237 (81.4%) were married, 229 (78.7%) were educated lower than 12 years, 250 (85.9%) were living in urban areas, and (221) 75.9% had access to sanitary water in their living area. anti-HAV IgG was detected in 269 (92.4%, 95% CI: 89.4 - 95.4%) patients. Multivariable analysis showed that lower knowledge of hepatitis A transmission routes (OR: 11.9, 95% CI: 1.39 - 101.8, P = 0.024), no waterpipe smoking (OR: 9.5, 95% CI: 1.6 - 55.5, P = 0.014), and older age (OR: 1.12, 95% CI: 1 - 1.24, P = 0.03) were the main predictors of HAV immunity, in sequence. Conclusions: Most LT candidates are HAV IgG positive, but due to the growing number of LT candidates and high mortality of HAV in non-immune cases, LT candidates should be checked for HAV IgG, especially younger or waterpipe smoking patients who are less immune. Also, all non-immune patients should be vaccinated against HAV, if possible.