The Immunogenicity of Influenza Virus Vaccine in Solid Organ Transplant Recipients

SummaryBackground and objectives In 2009, the pandemic influenza A/H1N1 accounted for worldwide recommendations about vaccination. There are few data concerning the immunogenicity or the security of the adjuvanted-A/H1N1 vaccine in transplanted and hemodialyzed patients.Design, setting, participants, & measurements Sera from 21 controls, 53 hemodialyzed (HD) patients, and 111 renal transplant recipients (RT) were sampled before (T0) and 1 month after (T1) a single dose of Pandemrix® vaccine (GSK Biologicals, AS03-adjuvanted). We measured the neutralizing antibodies against A/H1N1/2009, the geometric mean (GM) titers, the GM titer ratios (T1/T0) with 95% confidence intervals, and the seroconversion rate (responders: Ն4-fold increase in titer). The HLA and MICA immunization was determined by Luminex technology. ResultsThe GM titer ratio was 38 (19 to 78), 9 (5 to 16), and 5 (3 to 6) for controls, HD patients, and RT patients, respectively (P Ͻ 0.001). The proportion of responders was 90%, 57%, and 44%, respectively (P Ͻ 0.001). In RT patients, the prevalence of histocompatibility leukocyte antigen (HLA) class I, histocompatibility leukocyte antigen class II, and MHC class I-related chain A immunization, was, respectively, 15%, 14%, and 14% before and 14%, 14%, and 11% after vaccination (P ϭ 1, 1, and 0.39). ConclusionsThe influenza A/H1N1-adjuvanted vaccine is of limited efficacy but is safe in renal disease populations. The humoral response is lower in transplanted versus hemodialyzed patients. Further studies are needed to improve the efficacy of vaccination in those populations.

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“…Further trials with higher vaccine doses and/or a booster may be warranted in these populations (9,35). …”

Section: Discussionmentioning

confidence: 99%

Influenza A/H1N1 Vaccine in Patients Treated by Kidney Transplant or Dialysis

Broeders

Hombrouck²,

Lemy³

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…To our knowledge, only 5 studies are available on the efficacy of influenza vaccination in liver transplant recipients: 2 studies of pediatric populations 62,63 and 3 studies of adult populations. [64][65][66] Data on patients with cirrhosis are limited to 1 study. 66 For this reason, most of the information on the safety and efficacy of vaccination is extrapolated from studies of other solid-organ or bone marrow transplant recipients, as well as other immunodepressed populations (Tables 2 and 3).…”

Section: Vaccinationmentioning

confidence: 99%

“…However, the response rate at 28 days was less in liver transplant recipients compared with controls and patients with cirrhosis. 66 However, others have found an impaired immune response to influenza virus vaccine in recipients of solid-organ transplants, 64 including heart 68 and kidney. 69,70 Immunosuppression regimens appear to be an important variable explaining the divergence of vaccine efficacy.…”

Section: Vaccinationmentioning

confidence: 99%

Influenza Infection in Patients Before and After Liver Transplantation

Duchini¹

2000

Liver Transplantation

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Infection with influenza virus poses specific problems in pediatric and adult liver transplant recipients, both before and after liver transplantation. These include a higher rate of pulmonary and extrapulmonary complications, development of rejection with graft dysfunction, prolonged shedding of influenza virus, and increased drug-resistance. Hepatic decompensation may occur during influenza infection in patients with cirrhosis. Current prophylaxis includes yearly vaccination with trivalent inactivated vaccine. Appropriate diagnosis and prompt treatment of any upper respiratory infections are indicated in these patients. In this review, we describe a case of influenza viral pneumonia in an adult liver transplant recipient, review basic and clinical aspects of influenza infection in this patient population, and discuss current modes of prevention and treatment in detail. (Liver Transpl 2000;6: 531-542.)

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“…This has been repeatedly shown with the influenza vaccine in liver transplant recipients. 11,12 Commercial recombinant HBsAg is effective in the general population, but has significant limitations in the "poor responder" groups, i.e., dialysis, cirrhosis, chemotherapy, and transplantation patients. In this setting, a variety of approaches have been used to produce a more "immunogenic" vaccine such as adding cytokines (interleukin 12), 13 more potent adjuvants (CpG, fatty acids), 14,15 inclusion of pre-S1 and pre-S2 antigens, linking HBsAg to other more effective immunogens (tetanus toxoid or the pertussis vaccine), 16 DNA vaccines, 17 and complexing of HBsAg to anti-HBs.…”

mentioning

confidence: 99%

Vaccination for hepatitis B after transplantation: A realistic goal?

Pruett

2002

Hepatology

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L iver transplantation for hepatitis B has become remarkably successful over the past decade. This success has been predicated upon effective therapy to prevent clinical infection of the transplanted liver by hepatitis B virus (HBV). The cornerstone of therapy to prevent HBV infection in the transplanted liver has been the use of hepatitis B immune globulin (HBIG). With the availability of effective antiviral therapy (especially lamivudine with others soon to be available), the repertoire for HBV containment is increasing. There are significant shortcomings to longterm HBIG and lamivudine, not least of which has been cost and drug resistance. The prospect of inducing active immunity against HBV, without the need for additional treatment for the virus, was examined in the article by Angelico et al. in this issue of HEPATOL-OGY. 1 The immunization regimen was based on the knowledge that HBV vaccination in cirrhotic patients and non-HBV liver transplant recipients results in a low rate of hepatitis B surface antibody (anti-HBs) seroconversion. 2,3 The study included 17 virologically negative (hepatitis B surface antigen [HBsAg] and HBV-DNA negative by polymerase chain reaction on at least two consecutive assays) liver transplant recipients on cyclosporine monotherapy, who had undergone transplantation for HBV-related cirrhosis 25 to 85 months previously. Fifteen recipients were men. All patients were HBV-DNA negative (by hybridization assay) at the time of transplantation and 41% were hepatitis D antibody positive. HBIG monotherapy had been given to all patients on a monthly (typically about 5,000 IU) basis until entry into the study. Four weeks after the last dose of HBIG, the patients were started on lamivudine. The anti-HBs titers were followed until they were less than 10 IU/L, a median of 4.5 months after the last HBIG dose. The first course of vaccination used 40 g (double dose) recombinant HBsAg (Recombivax) given intramuscularly at 0, 1, and 2 months. Early response was defined as an anti-HBs titer greater than 100 IU/L at 3 months. One individual (5.9%) developed an early response with an anti-HBs titer of 687 IU/L at month 3 and one developed an anti-HBs titer of 20 IU/L. The 16 nonresponders were given a second course of vaccination: 10 g of recombinant HBsAg intradermally every 15 days for 3 months (6 doses). No additional patient developed an anti-HBs titer Ͼ100 IU/L, so all 16 were given a third vaccination series exactly the same as the first (40 g intramuscularly monthly for 3 doses). One patient responded at month 10 with an anti-HBs titer of 253 IU/L. In aggregate, 2 of 17 (12%) developed an anti-HBs titer greater than 100 IU/L and 3 more (18%) had a titer greater than 10 IU/L after the 3 vaccination courses. Per protocol, the 15 nonresponders resumed intravenous HBIG. Of two responders, one stopped lamivudine and one continued because the anti-HBs response was not durable. No patient developed HBV reinfection. The response in this series to a commercially available recombinant HBsAg vaccine was ...

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The Immunogenicity of Influenza Virus Vaccine in Solid Organ Transplant Recipients

Cited by 172 publications

References 15 publications

Influenza A/H1N1 Vaccine in Patients Treated by Kidney Transplant or Dialysis

Influenza A/H1N1 Vaccine in Patients Treated by Kidney Transplant or Dialysis

Influenza Infection in Patients Before and After Liver Transplantation

Vaccination for hepatitis B after transplantation: A realistic goal?

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