Duration of immunity to diphtheria and tetanus in young kidney transplant patients

Abstract

A considerable proportion of patients with renal transplant, evaluated many years after transplant, lack protective diphtheria antibody levels, despite primary immunization, but maintain immunity to tetanus. These patients respond to a diphtheria and tetanus booster but the duration of the response is uncertain. This study was undertaken to assess if protective antibodies evoked by primary immunization are lost quickly after transplantation, and whether the extent of the immune response to a booster influences the persistence of protective antibodies. We studied 15 patients (group 1) immediately after renal transplant and 35 patients with renal transplant for 6 +/- 4 yr who received a diphtheria and tetanus booster (group 2). Six patients (40%) of group 1 lost protective diphtheria antibodies a median time of 6.5 months after transplant. Thirty-three patients of group 2 responded to the booster with normal diphtheria antibody titers (> 1 IU/mL) in 22 cases and with low titers in 11. Four of the latter lacked immunity to diphtheria at 12 months follow-up. All patients with normal immunity maintained protective levels of diphtheria antibodies. The low responders had a creatinine clearance of 50 +/- 20 mL/min/1.73 m2. Tetanus immunity was maintained in almost all patients of both groups. In conclusion, renal transplant patients had an accelerated loss of diphtheria antibodies in the early post-transplant period. Response to a diphtheria booster identified a group at particular risk, namely the low responders, who may require frequent booster doses. This group had significantly poorer renal function than the normal responders.

Vaccinations for Adult Solid-Organ Transplant Recipients: Current Recommendations and Protocols

“…Booster vaccination for both diphtheria and tetanus was effective and safe in pediatric renal transplant recipients who had received their primary immunization before transplant (34). However, titers to diphtheria declined rapidly in the first 12 months after transplant, confirming what has been found in younger patients (81). This led to the recommendation in patients after renal transplantation to routinely administer tetanus and diphtheria boosters at regular intervals and assess postvaccination titers every 5 years for tetanus and not later than 2 years after vaccination for diphtheria.…”

Immunization in children with chronic renal failure: a practical approach

“…This problem could be overcome in some patients by repeated vaccinations (with increasing dose) [27,45]. Secondly, vaccine serum antibodies in children with CRF have a tendency to wane over a short period of time, i.e., 6-12 months [27,41,42,45,51,52,54,56]. Therefore, repeated measurement of serum antibodies with appropriate revaccination has been recommended [17,27,45,51,54].…”

“…The majority of previous reports focused on the safety and short-term immunogenicity [28,29,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55], whereas data on the long-term clinical efficacy are rare [21,27,56].…”

“…Killed or component vaccines have not shown any deleterious effect on renal function in children on conservative treatment or after RTPL; in particular, there was no evidence of an increased rate of graft rejection and the efficacy of dialysis was not affected in children on either peritoneal or hemodialysis [27,38,39,40,41,42,43,44,45,48,49,50,51,52,53,54,55].…”

“…Also, administration of boosters after RTPL induced a significant antibody response: diphtheria [39,41] and tetanus [39,41].…”