Evaluation of immunity status to routine vaccination in pediatric liver transplant candidates

Abstract

Background/Aims: Generally, prevention of infections by vaccination is the least invasive and most cost-effective approach to reduce the incidence of infections and the morbidity and mortality in transplant recipients. Genetic diversity and different liver disease among patients contributes to variability in immune responses to vaccines and pathogens. The aim of this study was to evaluate immunity status to different vaccinated organisms in pediatric liver-transplant candidates. Materials and Methods: The vaccination charts of 90 patients who were referred to Organ Transplant Center of Shiraz University of Medical Sciences were reviewed and compare with National Immunization Program recommendation, after that 10 mL blood was drawn from these patients for serologic studies by ELISA. Results: Eighty percent of the patients had protective antibody titers for poliomyelitis, 65.6% for rubella, 62.3% for diphtheria, 60% for tetanus, 57.7% for pertussis, 55.5% for measles, 42.2% for hepatitis B and 36.7% for mumps. Conclusion: Overall seroconversion rates were not satisfactory for many infections that may be due to lower rate of vaccination or even the underlying liver disease that interfere with optimal immunogenecity of vaccination. Therefore, vaccination charts should be periodically reviewed and updated, also repeated measurements of serum antibodies and appropriate revaccination if titers decline is recommended to prevent the vaccine-preventable disease in liver transplant candidates after transplant.

Bile Acids Impair Vaccine Response in Children With Biliary Atresia

“…One of the biggest challenges for BA patients is the high risk of HBV infection, given that 7-10% of the Chinese population is chronically infected with HBV (22), leading to a 1/4 risk of death from liver cancer or liver failure (23). Although timing and full-dose vaccination are critical before transplantation, the overall vaccination coverage of BA patients is generally poor for the following reasons: 1) delayed vaccination because of hospitalization; 2) parents and/or doctors who worry that vaccination might interfere with or worsen liver injury; and 3) BA patients who are too young (≤ 6 months) to receive 3 full doses of the vaccine (24,25). Unfortunately, even with the same doses of the HBV vaccine, the antibody titers of BA children are significantly lower than those of age-matched healthy children (26), and the mechanism that impairs HBV vaccine responses in BA children is unclear.…”

Measles hepatitis in a vaccinated liver transplant recipient: case report and review of literature

“…They are prone to serious consequences of any infection due to impaired clinical signs and rapid progression of disease. Pretransplant immunization is part of routine prophylaxis against many viral infections but does not confirm long‐lasting protection against these infections in the post‐transplant period due to waning immunity . Post‐transplant vaccination with live vaccines has been suggested by many reports but is not a part of guidelines due to risk of clinical disease from the live vaccine strain .…”