Antibody Response to Influenza Immunization in Kidney Transplant Recipients Receiving either Azathioprine or Mycophenolate: A Controlled Trial

Abstract

Aims: We aimed to assess humoral immune response to the influenza vaccine in adult kidney transplant recipients (KTRs) subjected to two immunosuppressive regimens containing either mycophenolate mofetil (MMF) or azathioprine (Aza). Methods: 40 eligible KTRs (24 treated with Aza [KTRs-Aza] and 16 treated with MMF [KTRs-MMF]) and 40 matched healthy controls (HCs) were administered the trivalent 2006–2007 anti-influenza vaccine. Antibody (Ab) titers were measured before (pre-vacc) and 1 month after (post-vacc) vaccination. The proportion of protective Ab titers (i.e. ≧1:40), the serological response (i.e. ≧4-fold rise in titers) rates, and the magnitudes of change in titers were evaluated. Results: KTRs and HCs were similar in serologic responses, magnitudes of change in Ab titers, and proportions of acquired protective titers against all antigens. Whereas KTRs-MMF and KTRs-Aza were identical in magnitude of rise in titers as well as in serologic responses, KTRs-MMF did poorer in developing post-vacc-protective titers against A/H1N1 (p < 0.05). The function of the transplanted kidney has not deteriorated after vaccination. Conclusions: Anti-influenza vaccination was safe in KTRs and evoked Ab responses comparable to those of HCs. KTRs-MMF and KTRs-Aza responded almost equally to the vaccine. Annual anti-influenza vaccination can be recommended to all stable KTRs.

Humoral and Cellular Immune Responses after Influenza Vaccination in Kidney Transplant Recipients

“…In our study, the use of a highly sensitive technique allowed us to identify a significant proportion of patients (22 (10,13,34,35 (12)(13)(14) as well as to other types of vaccine such as hepatitis B (37,38), presumably linked to immunosuppressive therapy (14)(15)(16)(17). They differ from other studies showing adequate humoral responses (7)(8)(9)(10)(11) (10,11,15,16 (17). A similar dissociation between humoral and cellular responses has also been described in children after hematopoietic stem cell transplantation (42) and elderly subjects (43) …”

Outcomes Associated with Influenza Vaccination in the First Year after Kidney Transplantation

“…This study also excluded patients within 6 months of transplant but did capture some patients earlier after transplant with vaccination ranging from 6 to 312 months after transplant (5,8). Two smaller studies from Poland and Greece showed similar results (9,10).…”

Influenza Vaccination in the Organ Transplant Recipient: Review and Summary Recommendations

“…Several studies have assessed the effects of mycophenolate mofetil (MMF) on immune responses, with two reports finding comparable responses to azathioprine (33,38), whereas others have found diminished antibody responses in MMF-treated patients (39)(40)(41). In a recent trial of 165 kidney recipients, Scharpe et al found that although MMF was associated with a 2.6-to 5-fold lower seroresponse rate, patients still had acceptable levels of seroprotection after immunization (23).…”