A Prospective Cohort Study of Hepatitis B Virus Vaccination in Pediatric Heart Transplant Recipients: Cellular and Humoral Immune Responses and the Role of Innate Immunity.

BACKGROUND: Vaccination is a key strategy to reduce infectious disease mortality. In pediatric heart transplant recipients (HTRs), the use of immunosuppressive therapy weakens immune responses, increasing the risk of viral infections. This study aimed to evaluate the immunogenicity of hepatitis B virus (HBV) revaccination in this vulnerable population.

METHODS: A prospective longitudinal study was conducted in HTRs under 18 years of age who received HBV revaccination. Blood samples were collected at study inclusion (baseline) and after the final vaccine dose post-solid organ transplant (SOT; follow-up). Seroprotection was measured by quantifying plasma antibodies to hepatitis B surface antigen (anti-HBs) IgG. Cellular responses were assessed by flow cytometry, evaluating HBV-specific T-cell and natural killer (NK) cell activity following in vitro stimulation with HBV peptides.

RESULTS: Twenty-three patients (median age, 9 years; 70% male) were included, with a median posttransplant time of 13 months. All received tacrolimus; most received mycophenolate (87%) and corticosteroids (39%). Post-SOT seroprotection was achieved in 48% of patients, and 82% showed HBV-specific CD4+ and CD8+ T-cell responses. Higher vaccine doses (3-4 doses) were associated with stronger immune responses. NK cell responses were observed in 56% (total NK cells) and 61% (NK T cells). NK responders showed higher expression of the activating receptor NKG2C. Baseline monocyte, dendritic cell and memory T-cell frequencies were positively correlated with post-SOT vaccination response.

CONCLUSIONS: Pediatric HTRs showed a generally good immune response to HBV revaccination, especially with higher vaccine doses. The immune profile at the time of vaccination appears to influence outcomes, supporting personalized vaccination approaches in immunosuppressed populations.