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.
Vaccine-preventable viral infections are associated with increased risk of morbidity and mortality in posttransplant patients on intensive immunosuppression regimens. Of particular concern, is the 2019 CDC data indicating the largest number of cases of measles reported in the United States since 1992. Current guidelines recommend routine screening and vaccination of all patients prior to solid organ transplantation. We studied rates of immunity against vaccine-preventable viruses in a large single center cohort of patients undergoing evaluation for lung transplantation (LT) and sought to determine if impaired immunity was associated with native disease or other demographic factors. METHODS: We retrospectively studied consecutive adult patients who underwent evaluation for lung transplantation at Duke University Medical Center between January 2016 and October 2018. Viral titers measured in the evaluation were: measles, mumps and varicella zoster virus (VZV). Clinical and demographic information were extracted from the electronic medical record. Association modeling was performed using logistic and Poisson regression. An absent IgG level for each viral infection of interest was regarded as an undetectable titer. RESULTS: 703 patients underwent LT evaluation (58.7% male, median (Q1, Q3) age 62 (53, 68) years). 235 (33.4%) patients received a lung transplant, while 468 (66.6%) patients did not undergo transplantation during the study period. Percentages of patients who lacked immunity to vaccine-preventable infections at evaluation were: measles (10.8%), mumps (14.2%) and VZV (3.6%). Strikingly, many Cystic Fibrosis (CF) patients had undetectable titers to measles (17.9%), mumps (13.4%), and VZV (13.4%). When compared to other native diseases, CF was associated with a higher odds of undetectable titers for VZV (P<0.05) with a trend towards undetectable titers for measles (p=0.053). Patients born after 1970 had the highest odds of absent titers for all (P<0.05) with 25.9%, 21.4%, and 10.7% of these patients having undetectable measles, mumps, and VZV titers, respectively. CONCLUSION: A substantial number of patients undergoing LT evaluation are not immune to vaccine-preventable viruses at the time of initial assessment. In particular, young patients with chronic disease may have a blunted immunologic response to their childhood vaccines or an accelerated rate of vaccination titer losses. Our results emphasize the importance of screening for vaccine-preventable infections particularly in younger patients with CF and the opportunity for revaccination in selected patients in order to boost their humoral immunity prior to receiving transplant immunosuppression.
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