Low rates of vaccination in listed kidney transplant candidates

Abstract

Despite clear consensus and strong recommendations, vaccination rates of kidney transplant (KT) recipients have remained below targets. As vaccination is most effective if it is given prior to transplantation and the initiation of immunosuppression, patients should ideally have their vaccination status assessed and optimized in the pre-transplant period. We performed a retrospective chart review to characterize vaccination rates and factors associated with gaps in vaccination in a single-center population of waitlisted patients being evaluated for kidney transplantation. We evaluated 362 KT patients. Three-quarters were receiving dialysis at the time of evaluation. Immunization rates were low with 35.9% of patients having completed vaccination for Pneumococcus, 55% for influenza, 6.9% for zoster, and 2.5% for tetanus. On multivariable analysis, patients who received other vaccines, including influenza, tetanus, or zoster vaccine (odds ratio [OR] 10.55, 95% confidence interval [CI] 5.65-19.71) were more likely to receive pneumococcal vaccine. Blacks (OR 0.24, 95% CI 0.12-0.47) were less likely to receive pneumococcal vaccine compared to whites. Patients on dialysis, and those active on the waiting list were more likely to receive pneumococcal vaccine than other groups (OR 2.81, 95% CI 1.44-5.51, and OR 1.84, 95% CI 1.08-3.14, respectively). We found that the overall immunization rate against common vaccine-preventable infections was low among patients evaluated for kidney transplantation. A significant gap remains between recommendations and vaccine uptake in clinical practice among this high-risk population.

Immunization in end stage renal disease: The perception of waiting list patients

“…The only exception was for hepatitis B, whose risk was of 23%, comparable to previous reports . Despite the higher rate of hepatitis B immunization, about a quarter of patients received a 3‐dose regimen, different from the recommendation of 4‐double dose regimen for CKD patients …”

Serologic screening and infectious disease consultation (IDC): Indicated in heart, lung, liver (HLL) solid organ transplants (SOT) for measles, mumps, rubella, and varicella

“…These percentages are not dependent on patients’ immune status or negative serology results. Lee et al performed a retrospective chart review of 362 kidney transplant patients in terms of receiving pneumococcus, influenza, tetanus, and zoster vaccines and found a significant gap between recommendations and vaccination in clinical practice among this vulnerable population . Weltermann et al conducted a cross‐sectional study and compared the prevalence of immunization rates in 444 liver transplant patients from the medical center with a general population sample.…”

A randomized, placebo‐controlled phase I trial of live, attenuated herpes zoster vaccine in subjects with end‐stage renal disease immunized prior to renal transplantation

“…Although ESRD and dialysis are not contraindications to receiving shingles vaccine, utilization in this population has been low and appears to be even lower in subjects awaiting transplant . This likely reflects concerns about immunogenicity, safety of a high‐titer live virus vaccine, and potential sensitization to HLA by vaccines and non‐specific pro‐inflammatory stimuli in subjects who may receive a transplant.…”