Effects of the influenza vaccine on pediatric kidney transplant outcomes

Abstract

The influenza vaccine is critical for preventing influenza‐related complications in transplant patients. Previous studies demonstrated de novo donor‐specific antibody formation and rejection following the influenza vaccination. This risk has not been adequately assessed in the pediatric population. We performed a single‐center retrospective analysis of 187 unique pediatric kidney transplant recipients, transplanted from January 1, 2006, to December 31, 2015, assessing for an association of the influenza vaccination with various transplant outcomes. The influenza vaccine was received by 125 of 187 patients within the first year post‐transplant. Using log‐rank tests and Kaplan‐Meier curves, vaccinated patients had a significantly lower risk of mortality (P = 0.048). There were no differences in death‐censored graft survival (P = 0.253), graft survival (P = 0.098), or rejection (P = 0.195) between vaccinated and unvaccinated groups. To address the problem of multiple exposures for a yearly vaccine, Cox proportional hazards regression was utilized with post‐transplant vaccination status considered as a time‐dependent covariate; analyses were performed using both a 360‐ and 180‐day vaccination period following any post‐transplant influenza vaccination. In this model, being vaccinated did not result in a significant difference in mortality (HR 0.90 [0.16, 5.15], P = 0.91), death‐censored graft survival (HR 0.70 [0.31, 1.58], P = 0.39), graft survival (HR 0.69 [0.32, 1.49], P = 0.34), or rejection (HR 0.67 [0.37, 1.19], P = 0.17). Eight patients developed de novo donor‐specific antibodies following the first post‐transplant influenza vaccination; three then developed biopsy‐proven rejection. These results suggest influenza vaccination is safe in pediatric kidney transplant recipients, and larger prospective studies are required to conclusively confirm our findings.

Gaps in knowledge about the vaccine coverage of immunocompromised children: a scoping review

“…These include concerns about the safety and effectiveness of vaccines and lack of information about the vaccines. [41][42][43] Strategies to help improve vaccination may include increased education [44][45][46][47][48][49] and development of vaccination policies specific to immunocompromised populations. [50][51][52] Health-care providers should also consistently incorporate the review of vaccine records into their practice.…”

Approaches to safe living and diet after solid organ transplantation

“…Clinical trials have demonstrated that immunization strategies such as high‐dose influenza vaccination and vaccine booster regimens (ie, a second dose provided 5 weeks after the first) can improve immunogenicity 13,14 . Influenza vaccination does not increase the risk of graft rejection 15 …”

“…The booklet also contains information about why food safety is important for transplant recipients and practical tips for avoiding foodborne illness. Complementing the AST‐IDCOP guidelines, the AAP has issued a policy statement strongly recommending that all infants and children consume only pasteurized milk and milk products, and they also endorse a ban on the sale of raw milk products throughout the United States 15,63 . Specific food safety recommendations for pediatric transplant recipients are summarized in Table 2.…”

“…13,14 Influenza vaccination does not increase the risk of graft rejection. 15 Neuraminidase inhibitors such as oseltamivir, zanamivir, and peramivir, as well as cap-dependent endonuclease inhibitors such as baloxavir, 16 are the mainstays of the prevention and treatment of influenza infections. 17 Oseltamivir remains the most studied neuraminidase inhibitor in SOT recipients to date.…”

“…guidelines, the AAP has issued a policy statement strongly recommending that all infants and children consume only pasteurized milk and milk products, and they also endorse a ban on the sale of raw milk products throughout the United States. 15,63 Specific food safety recommendations for pediatric transplant recipients are summarized in Table 2. guidelines, and microbiologically proven foodborne infections occurred only among the subset of patients who did not follow food safety guidelines.…”