Vaccination titres pre- and post-transplant in paediatric renal transplant recipients and the impact of immunosuppressive therapy

Höcker, Britta; Aguilar, Martin; Schnitzler, Paul; Pape, Lars; Bald, Martin; König, Jens; Marks, Stephen D.; Genç, Gürkan; Büscher, Anja; Kemper, Markus J.; Billing, Heiko; Pöhl, Martin; Strologo, Luca Dello; Webb, Nicholas J.A.; Rieger, Susanne; Mankertz, Annette; Krupka, Kai; Brückner, Thomas; Fichtner, Alexander; Tönshoff, Burkhard

doi:10.1007/s00467-017-3868-0

Cited by 20 publications

(16 citation statements)

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“…Similar to our study, the younger patients in this prior cohort tended to have higher rates of undetectable titers raising concern over lack of sustained response to childhood vaccine series in those with concomitant illnesses or perhaps differences in age‐related vaccines practices or exposures. Furthermore, Hocker et al studied 155 pediatric renal transplant candidates and found that before transplantation, only 77.4% of patients had a positive measles titer, despite a complete vaccination schedule, compared to healthy children at 97% 5 . The same trends were found when the group studied mumps, rubella, and varicella titers in these children.…”

Section: Discussionmentioning

confidence: 83%

Immunity to varicella, measles, and mumps in patients evaluated for lung transplantation

Hostetler

Neely

Lydon

et al. 2021

American Journal of Transplantation

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Vaccine‐preventable viral infections are associated with increased risk of morbidity and mortality in post‐transplant patients on immunosuppression regimens. Therefore, we studied rates of immunity against vaccine‐preventable viruses in lung transplantation (LTx) candidates and their associations with underlying lung disease and clinical characteristics. We retrospectively studied 1025 consecutive adult patients who underwent first‐time evaluation for LTx at a single center between January 2016 and October 2018. Viruses studied included varicella zoster (VZV), measles, and mumps. Young age (17–48 years old) was negatively associated with immunity for VZV (OR 4.54, p < .001), measles (OR 15.45, p < .001) and mumps (OR 3.1, p < .001), as compared to those 65+. Many LTx candidates with cystic fibrosis (CF) had undetectable virus‐specific antibody titers including: 13.5% for VZV, 19.1% for measles, and 15.7% for mumps with significant odds of undetectable titers for VZV (OR 4.54, p < .001) and measles (OR 2.32, p = .010) as compared to those without CF. Therefore, a substantial number of patients undergoing LTx evaluation had undetectable virus‐specific antibody titers. Our results emphasize the importance of screening for immunity to vaccine‐preventable infections in this population and the need for revaccination in selected patients to boost their humoral immunity prior to transplantation.

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Section: Discussionmentioning

confidence: 83%

Immunity to varicella, measles, and mumps in patients evaluated for lung transplantation

Hostetler

Neely

Lydon

et al. 2021

American Journal of Transplantation

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“…28 These findings are consistent with the observations that rituximab eliminates peripheral B cell memory in a dose-dependent manner, 29 a depletion that may be prolonged. 30 Importantly however, 5 of 8 participants (63%), of whom 4 were not receiving immunosuppression, developed anti-HPV responses to vaccination despite rituximab exposure at least 6 months previously; other reports suggest that such patients may develop a vaccine response. 31 The HPV vaccination schedules used after allogeneic hematopoietic cell transplant were recommended by expert transplant and infectious disease committees following populationbased age recommendations.…”

Section: Discussionmentioning

confidence: 96%

Immune Response Following Quadrivalent Human Papillomavirus Vaccination in Women After Hematopoietic Allogeneic Stem Cell Transplant

et al. 2020

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IMPORTANCE Human papillomavirus (HPV) infection is found in about 40% of women who survive allogeneic hematopoietic stem cell transplant and can induce subsequent neoplasms.OBJECTIVE To determine the safety and immunogenicity of the quadrivalent HPV vaccine in clinically stable women post-allogeneic transplant compared with female healthy volunteers.INTERVENTIONS Participants received the quadrivalent HPV vaccine in intramuscular injections on days 1 and 2 and then 6 months later. DESIGN, SETTING, AND PARTICIPANTSThis prospective, open-label phase-1 study was conducted in a government clinical research hospital and included clinically stable women posttransplant who were or were not receiving immunosuppressive therapy compared with healthy female volunteers age 18 to 50 years who were followed up or a year after first receiving quadrivalent HPV vaccination. The study was conducted from June 2, 2010, until July 19, 2016. After all of the results of the study assays were completed and available in early 2018, the analysis took place from February 2018 to May 2019. MAIN OUTCOMES AND MEASURESAnti-HPV-6, -11, -16, and -18-specific antibody responses using L1 virus-like particle enzyme-linked immunosorbent assay were measured in serum before (day 1) and at months 7 and 12 postvaccination. Anti-HPV-16 and -18 neutralization titers were determined using a pseudovirion-based neutralization assay. RESULTS Of 64 vaccinated women, 23 (35.9%) were receiving immunosuppressive therapy (median age, 34 years [range, 18-48 years]; median 1.2 years posttransplant), 21 (32.8%) were not receiving immunosuppression (median age, 32 years [range, 18-49 years]; median 2.5 years posttransplant), and 20 (31.3%) were healthy volunteers (median age, 32 years [range, 23-45 years]). After vaccine series completion, 18 of 23 patients receiving immunosuppression (78.3%), 20 of 21 not receiving immunosuppression (95.2%), and all 20 volunteers developed antibody responses to all quadrivalent HPV vaccine types (P = .04, comparing the 3 groups). Geometric mean antibody levels for each HPV type were higher at months 7 and 12 than at baseline in each group (all geometric mean ratios >1; P < .001) but not significantly different across groups. Antibody and neutralization titers for anti-HPV-16 and anti-HPV-18 correlated at month 7 (Spearman ρ = 0.92; P < .001 for both). Adverse events were mild and not different across groups.CONCLUSIONS AND RELEVANCE Treatment with the HPV vaccination was followed by strong, functionally active antibody responses against vaccine-related HPV types and no serious adverse events. These findings suggest that HPV vaccination may be safely administered to women posttransplant to potentially reduce HPV infection and related neoplasia.

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“…Similarly, in another study, investigators revealed that the re-vaccination during the posttransplant period showed titer loss or failed to induce positive IgG for diphtheria, pertussis and hepatitis B in nearly 40% of their patients [22]. However, there are some controversial studies in the literature.…”

Section: Discussionmentioning

confidence: 97%

Serologic screening and infectious diseases consultation in renal transplant candidates for measles, mumps, rubella and varicella

Seckin

Libertin

Brumble

2021

Romanian Journal of Internal Medicine

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Background: Renal transplant recipients are at increased risk for developing complications of vaccine-preventable diseases. They benefit from a comprehensive pre-transplant evaluation when they might safely receive live vaccines. The primary aim of our study was to investigate the number of renal transplant recipients who were evaluated for serologic status against measles, mumps, rubella (MMR), and varicella. Secondarily, we investigated if pre-transplant Infectious Diseases consultation (IDC) improved vaccination rates.Methods: We retrospectively analyzed 282 kidney-alone and kidney-plus adult transplant recipients who were born in or after 1957. Patients were evaluated at Mayo Clinic, Florida Transplant Center between January 2015 and December 2017. Serologic status evaluation and vaccination rates were compared in two groups created based on IDC and no ID consultation (NIDC).Results: 235 (83%) of a total 282 patients received an IDC pre-transplantation. Varicella IgG levels were screened in all 235 IDC candidates. Among the IDC patients, mumps, measles and rubella IgG serologies were performed in 7 (3%), 143 (61%) and 144 (61%), respectively. Among 44 patients seronegative for any of MMR, 24 (55%) were vaccinated. Ten (66%) of 15 varicella seronegative patients were vaccinated. Zostavax was not given to 18% of IDC patients. Zostavax and MMR were administered more frequently in the IDC group compared to NIDC (p<.001 and p=0.0016, respectively).Conclusion: Although the majority of patients had IDC, the screening rate for MMR serologies was lower than varicella. A protocol-driven serologic screening similar to the one for VZV is required for MMR. Pre-transplant IDC increases vaccination rates.

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Vaccination titres pre- and post-transplant in paediatric renal transplant recipients and the impact of immunosuppressive therapy

Abstract: These data show a low percentage of patients with positive vaccination titres pre-transplant, a low revaccination rate post-transplant with limited antibody response, and a high rate of vaccination titre losses.

Cited by 20 publications

References 50 publications

Immunity to varicella, measles, and mumps in patients evaluated for lung transplantation

Immunity to varicella, measles, and mumps in patients evaluated for lung transplantation

Immune Response Following Quadrivalent Human Papillomavirus Vaccination in Women After Hematopoietic Allogeneic Stem Cell Transplant

Serologic screening and infectious diseases consultation in renal transplant candidates for measles, mumps, rubella and varicella

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