Updated data on effective and safe immunizations with live-attenuated vaccines for children after living donor liver transplantation

Shinjoh, Masayoshi; Hoshino, Ken; Takahashi, Tsuyoshi; Nakayama, Tetsuo

doi:10.1016/j.vaccine.2014.11.052

Cited by 50 publications

(80 citation statements)

References 15 publications

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“…Criteria for timing, immune suppression, and immune evaluation were adapted from previously published prospective studies . Posfay‐Barbe et al, Kawano et al, and Pittet et al all considered initiating immunization 1 year post‐transplant, whereas Shinjoh et al waited until 2 years post‐transplant.…”

Section: Outcomementioning

confidence: 99%

“…Literature review found only one reported case of acute rejection temporally associated with live vaccination, which occurred 21 days after measles‐containing vaccine in a liver transplant recipient (Table ). Based on evaluation of previous study protocols, the consensus forum recommended live vaccine administration at a minimum of 2 months post–rejection episode. This requires that the transplant recipient is receiving low‐level immune suppression, meets immunologic criteria, and has stable clinical status after the rejection episode.…”

Section: Outcomementioning

confidence: 99%

“…Immune suppression thresholds believed to be safe for administration of live viral vaccines in previous studies ranged from (i) tacrolimus levels of <5 to <8 ng/mL, (ii) cyclosporine levels <100 ng/mL, and (iii) prednisone equivalent doses ranging from discontinuation for at least 6 months to <2 mg/kg/d . Patients receiving sirolimus were not included in these studies.…”

Section: Outcomementioning

confidence: 99%

“…Section 4 further details the evidence and recommendations for immune evaluation. In general, patients who have no clinical suspicion for an underlying immune deficiency and are not on novel (obinutuzumab) or high levels of immune suppression are recommended to have a CD4 count and absolute lymphocyte count to ensure current immune suppression is not causing significant lymphopenia/CD4+ lymphopenia (see Table and Section 4), as defined in the literature …”

Section: Outcomementioning

confidence: 99%

See 3 more Smart Citations

Live vaccines after pediatric solid organ transplant: Proceedings of a consensus meeting, 2018

Suresh

Upton

Green

et al. 2019

Pediatric Transplantation

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Growing evidence suggests receipt of live‐attenuated viral vaccines after solid organ transplant (SOT) has occurred and is safe and needed due to lapses in herd immunity. A 2‐day consortium of experts in infectious diseases, transplantation, vaccinology, and immunology was held with the objective to review evidence and create expert recommendations for clinicians when considering live viral vaccines post‐SOT. For consideration of VV and MMR post‐transplant, evidence exists only for kidney and liver transplant recipients. For MMR vaccine post‐SOT, consider vaccination during outbreak or travel to endemic risk areas. Patients who have received antiproliferative agents (eg. mycophenolate mofetil), T cell–depleting agents, or rituximab; or have persistently elevated EBV viral loads, or are in a state of functional tolerance, should be vaccinated with caution and have a more in‐depth evaluation to define benefit of vaccination and net state of immune suppression prior to considering vaccination. MMR and/or VV (not combined MMRV) is considered to be safe in patients who are clinically well, are greater than 1 year after liver or kidney transplant and 2 months after acute rejection episode, can be closely monitored, and meet specific criteria of “low‐level” immune suppression as defined in the document.

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Section: Outcomementioning

confidence: 99%

Section: Outcomementioning

confidence: 99%

Section: Outcomementioning

confidence: 99%

Section: Outcomementioning

confidence: 99%

See 2 more Smart Citations

Live vaccines after pediatric solid organ transplant: Proceedings of a consensus meeting, 2018

Suresh

Upton

Green

et al. 2019

Pediatric Transplantation

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“…Forty‐nine percent of these patients had received pretransplant measles vaccine. The duration of seropositivity in these patients was a median of 25 months with 63% of patients remaining seropositive at 5 years postvaccination . Although limited, these studies suggest a beneficial effect of pretransplant measles immunization on seroresponse to posttransplant measles immunization.…”

Section: Measlesmentioning

confidence: 99%

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

Dulek

Maurice

Halasa

2018

Pediatric Transplantation

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Infections significantly impact outcomes for solid organ and hematopoietic stem cell transplantation in children. Vaccine-preventable diseases contribute to morbidity and mortality in both early and late posttransplant time periods. Several infectious diseases and transplantation societies have published recommendations and guidelines that address immunization in adult and pediatric transplant recipients. In many cases, pediatric-specific studies are limited in size or quality, leading to recommendations being based on adult data or mixed adult-pediatric studies. We therefore review the current state of evidence for selected immunizations in pediatric transplant recipients and highlight areas for future investigation. Specific attention is given to studies that enrolled only children.

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Safety and Immunogenicity of Live Viral Vaccines in a Multicenter Cohort of Pediatric Transplant Recipients

Feldman,

Beaty,

Ferrolino

et al. 2023

JAMA Netw Open

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ImportanceLive vaccines (measles-mumps-rubella [MMR] and varicella-zoster virus [VZV]) have not been recommended after solid organ transplant due to concern for inciting vaccine strain infection in an immunocompromised host. However, the rates of measles, mumps, and varicella are rising nationally and internationally, leaving susceptible immunocompromised children at risk for life-threating conditions.ObjectiveTo determine the safety and immunogenicity of live vaccines in pediatric liver and kidney transplant recipients.Design, Setting, and ParticipantsThis cohort study included select pediatric liver and kidney transplant recipients who had not completed their primary MMR and VZV vaccine series and/or who displayed nonprotective serum antibody levels at enrollment between January 1, 2002, and February 28, 2023. Eligibility for live vaccine was determined by individual US pediatric solid organ transplant center protocols.ExposuresExposure was defined as receipt of a posttransplant live vaccine. Transplant recipients received 1 to 3 doses of MMR vaccine and/or 1 to 3 doses of VZV vaccine.Main Outcome and MeasureSafety data were collected following each vaccination, and antibody levels were obtained at 0 to 3 months and 1 year following vaccination. Comparisons were performed using Mann-Whitney U test, and factors associated with development of postvaccination protective antibodies were explored using univariate analysis.ResultsThe cohort included 281 children (270 [96%] liver, 9 [3%] kidney, 2 [1%] liver-kidney recipients) from 18 centers. The median time from transplant to enrollment was 6.3 years (IQR, 3.4-11.1 years). The median age at first posttransplant vaccine was 8.9 years (IQR, 4.7-13.8 years). A total of 202 of 275 (73%) children were receiving low-level monotherapy immunosuppression at the time of vaccination. The majority of children developed protective antibodies following vaccination (107 of 149 [72%] varicella, 130 of 152 [86%] measles, 100 of 120 [83%] mumps, and 124 of 125 [99%] rubella). One year post vaccination, the majority of children who initially mounted protective antibodies maintained this protection (34 of 44 [77%] varicella, 45 of 49 [92%] measles, 35 of 42 [83%] mumps, 51 of 54 [94%] rubella). Five children developed clinical varicella, all of which resolved within 1 week. There were no cases of measles or rubella and no episodes of graft rejection within 1 month of vaccination. There was no association between antibody response and immunosuppression level at the time of vaccination.Conclusions and RelevanceThe findings suggest that live vaccinations may be safe and immunogenic after solid organ transplant in select pediatric recipients and can offer protection against circulating measles, mumps, and varicella.

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Updated data on effective and safe immunizations with live-attenuated vaccines for children after living donor liver transplantation

Cited by 50 publications

References 15 publications

Live vaccines after pediatric solid organ transplant: Proceedings of a consensus meeting, 2018

Live vaccines after pediatric solid organ transplant: Proceedings of a consensus meeting, 2018

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

Safety and Immunogenicity of Live Viral Vaccines in a Multicenter Cohort of Pediatric Transplant Recipients

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