American Board of Internal Medicine (ABIM) Certification Practice Exam

When should a complete Hepatitis A immunization series be given in solid organ transplantation?

1. After transplantation

2. Before transplantation if not already immune

3. Only if symptoms develop

4. Immediately post-surgery

The correct answer is: Before transplantation if not already immune

The complete Hepatitis A immunization series should be administered before transplantation if the patient is not already immune. This is crucial for several reasons. First, solid organ transplant recipients are at an increased risk for infections, including Hepatitis A, due to the immunosuppressive therapy they will receive post-transplant to prevent organ rejection. Vaccination before the transplant helps to ensure that the patient has developed adequate immunity to Hepatitis A, which can help protect them during their vulnerable post-transplant period. Additionally, there is a recommendation for vaccination protocols to establish immunity before transplantation, as it may take several weeks to months for a full response to the vaccine. This timing ensures that by the time the patient undergoes surgery, they have adequate protection against Hepatitis A. Administering the vaccine after transplantation or immediately post-surgery can put the patient at risk for Hepatitis A infection since their immune system would be compromised and may not respond appropriately to the vaccine. Waiting until symptoms develop is not a preventative approach and would not ensure immunity prior to potential exposure to the virus. Thus, ensuring vaccination prior to the transplant is the most effective strategy for protection against Hepatitis A in this vulnerable population.