Serostatus following live attenuated vaccination administered before pediatric liver transplantation

Abstract

After liver transplantation (LT), live attenuated vaccines (LAVs) are generally contraindicated. LAVs are recommended before LT for patients 6 months of age. However, the evidence supporting this practice is limited. Patients were enrolled before and after LT. Clinical data for patients were obtained from medical records. Serum antibody titers were evaluated at the time of enrollment and prospectively. Serum antibody titers were measured with a hemagglutination inhibition test for measles and rubella and with an enzyme-linked immunosorbent assay for varicella and mumps. Univariate and multivariate analyses were performed to investigate the factors that affect the serostatus. Serological analyses of 49 patients immunized before LT (median age, 45 months; male, 35%) were performed. Underlying diseases were biliary atresia (n 5 27; 55%), metabolic diseases (n 5 13; 27%), fulminant hepatic failure (n 5 5; 10%), and others (n 5 4; 8%). The seropositivity rate after each vaccine was 46.9% (measles), 89.4% (rubella), 67.5% (varicella), and 48.8% (mumps). Factors independently associated with seronegativity were a vaccination age < 12 months for measles (P 5.002), a lower body weight for varicella (P 5 0.01), and underlying diseases other than biliary atresia for mumps (P 5.004). No serious adverse event was observed during the study period. The immunogenicity of LAVs before LT was high for rubella but low for the others. Before LT, further vaccination strategies are needed for patients. In addition, serological follow-up may be indicated for patients with factors associated with seronegativity. Liver Transpl 21:774-783, 2015. V C 2015 AASLD.Received December 11, 2014; accepted February 26, 2015. Organ transplant candidates and recipients are at higher risk for infectious complications. In this particular population, vaccine-preventable diseases such as measles 1 and varicella 2 can actually be lifethreatening. For these individuals, inactivated vaccines are considered safe and are usually Additional Supporting Information may be found in the online version of this article.

A community divided: Post‐transplant live vaccine practices among Society of Pediatric Liver Transplantation (SPLIT) centers

“…[19][20][21] In a study by Funoki et al of children undergoing liver transplant, the seropositivity rates after live vaccination pre-liver transplant were 47% for measles, 49% for mumps, and 68% for varicella. 22,23 Finally, even in those children who enter transplant with protective antibodies, immunosuppressive medications may result in waning immunity over time. 5,7,[24][25][26] In a study of pediatric liver transplant recipients who entered liver transplant immune to measles and varicella, 22% lost immunity to measles and 63% lost immunity to varicella between two to seven years post-transplant.…”

Vaccines in pediatric transplant recipients—Past, present, and future

“…Only 47% of vaccine recipients remained measles seropositive at that time. 103 Other studies have similarly shown either poor seroconversion pretransplant or loss of measles antibody posttransplant. 79,104 Of note the clinical significance of seroreversion is unclear, as patients with seroreversion may still possess cell-mediated measles-specific immune memory.…”

“…In a prospective vaccine study in pediatric liver transplant recipients, 49 patients received pretransplant measles vaccine and measles serostatus was measured a median of 21 months posttransplant. Only 47% of vaccine recipients remained measles seropositive at that time . Other studies have similarly shown either poor seroconversion pretransplant or loss of measles antibody posttransplant .…”

Serostatus following polio‐containing vaccination before and after liver transplantation

“…The NCCHD has an original vaccination protocol for LT recipients before and after LT. 11 LT candidates received polio vaccinations before their scheduled transplantation according to the NIP in Japan.…”