Decreased Antibody Response to Influenza Vaccination in Kidney Transplant Recipients: A Prospective Cohort Study

Abstract

Background Antibody response to the inactivated influenza vaccine is not well described in kidney transplant recipients on newer, but commonly used, immunosuppression medications. We hypothesized that kidney transplant recipient participants on tacrolimus-based regimens would have decreased antibody response compared with healthy controls. Study Design Prospective cohort study of 53 kidney transplant recipient and 106 healthy control participants over the 2006–2007 influenza season. All participants received standard inactivated influenza vaccine. Setting and participants Kidney transplant recipients on tacrolimus-based regimens at a single academic medical center and healthy controls. Predictor Presence of kidney transplant. Outcomes Proportion of participants achieving seroresponse (four-fold rise in antibody titer) and seroprotection (antibody titer greater than 1:32) one month after vaccination. Measurements Antibody titers before vaccination and one month after vaccination using hemagglutinin inhibition assays for influenza types A/H1N1, A/H3N2, and B. Results A smaller proportion of the transplantation group compared with the healthy control group developed the primary outcomes of seroresponse or seroprotection for all three influenza types at one month post vaccination. The response to influenza type A/H3N2 was statistically different, with the transplantation group having 69% decreased odds of developing seroresponse (95% CI 0.16 to 0.62, P = 0.001) and 78% decreased odds of developing seroprotection (95% CI 0.09 to 0.53, P = 0.001) compared with healthy controls. When participants less than 6 months from time of transplantation were considered, this group had significantly decreased response to the vaccine as compared with healthy controls. Limitations Decreased sample size; potential for confounders; outcome measure used is the standard but does not give information about vaccine efficacy. Conclusions Kidney transplant recipients, especially within 6 months of transplantation, had diminished antibody response to the 2006–07 inactivated influenza vaccine.

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

“…Conversely, a series of 51 liver transplant recipients found vaccine responses corresponded with the length of time after transplant with H1 strain responses of 1/7 (14%) within 4 months of transplant, 6/9 (67%) within 4-12 months, and 30/35 (86%) within 12 months posttransplant; overall, more than 55% of the subjects vaccinated 4-12 months posttransplantation had adequate seroconversion to the three strains of the influenza vaccine (31). This was confirmed by a more recent study that showed significantly lower antibody titers in kidney transplant recipients vaccinated within 6 months of transplantation when compared to healthy controls (29). However, responses were similar to healthy controls if transplant patients were vaccinated after six months.…”

Humoral, T-cell and B-cell immune responses to seasonal influenza vaccine in solid organ transplant recipients receiving anti-T cell therapies

“…The hemagglutination inhibition (HI) assay correlates with vaccine protection in immunocompetent patients, but it remains unclear whether the HI assay can predict protection against influenza in patients receiving immunosuppressive drugs, such as in SOT recipients [10][11][12]. Cell-mediated immunity appears to be a promising predictor of vaccine response [13][14][15].…”

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

“…Immunosuppression is most potent in the first year of transplant, and it is currently unknown whether or not immunization in the first year after transplantation is effective in preventing influenza infections or reducing their severity. There is literature to suggest that the influenza vaccine may not be effective after renal transplant on the basis of the inability to form seroprotective levels of antibodies (4,5).…”