Response of transplant recipients to influenza vaccination based on type of immunosuppression: A meta-analysis

Abstract

Influenza vaccination is widely used in transplant recipients, but there is little known about the significance and correlating factors of its effectiveness. In the current study, we reviewed the existing literature on clinical trials performed in transplant recipients on the effectiveness of influenza vaccination and to evaluate the relevance of the type of immunosuppression employed in these patients on the humoral reaction to the vaccine. A comprehensive search of the literature was performed through Pubmed and Google Scholar to find reports indicating immunogenicity of influenza vaccination in transplant patients. Finally, data from 15 published clinical trials were included in the meta-analysis. Data of 947 transplant recipients retrieved from 15 clinical trials investigating the immunogenicity of influenza vaccination were analyzed in this meta-analysis. Analysis showed significantly lower rates of sero-conversion among transplant recipients receiving mycophenolate mofetil (MMF) than other immunosuppressive agents (relative risk: 0.724; 95% confidence interval: 0.596-0.880; P = 0.001). No significant correlation was found with tacrolimus, sirolimus, cyclosporine and azathioprine. Different immunosuppressive agents seem to have different effects on the humoral response rate to influenza vaccination, with MMF having the most significant deleterious effect. The limited and controversial data available in the literature do not support any differential effect for other immunosuppressive agents.

Varicella-zoster-virus vaccination in immunosuppressed children with rheumatic diseases using a pre-vaccination check list

“…The alternative is to delay the initiation of IS, use a low-dose glucocorticoid bridging therapy or interrupt IS for several weeks [ 17 , 27 ]. In our experience, the latter approach is often refused both by treating physicians and patients due to an increased risk of disease flares.…”

Vaccinations in Patients Receiving Systemic Drugs for Skin Disorders: What Can We Learn for SARS-Cov-2 Vaccination Strategies?

“…Studies have mainly been conducted in transplant patients and have revealed decreased immunologic responses after vaccination for influenza, tetanus, and hepatitis B [ 16 , 17 ]. In most studies, the administration of cyclosporine seems to be not associated with a reduced immune response to influenza vaccination compared with other immunosuppressants [ 18 ]. Nonetheless, in lung transplant patients, antibody responses were borderline significantly decreased in the cyclosporine versus the tacrolimus group [ 19 ].…”

“…This may not be surprising, as MMF is particularly useful in blistering skin disorders as it reduces pathogenic antibody formation. Significantly reduced antibody titers were confirmed in patients receiving MMF after pneumococcus and influenza vaccination [ 18 , 20 ]. MMF has a half-life of 15.7–17.9 h [ 21 ].…”

Seasonal influenza vaccine in immunocompromised persons

“…No significant correlation of low immunogenicity was detected with tacrolimus, sirolimus, cyclosporine, and azathioprine. 51 Induction immunosuppression may not impact vaccine immunogenicity. In a kidney transplant cohort in which thymoglobulin or basiliximab was used as induction therapy, 60 patients were evaluated for the immune response to IIV.…”