Establishing best practices in measles, mumps, and rubella serologic screening for kidney transplant candidates

Abstract

Preventing infections post-transplantation has been shown to greatly improve outcomes in KT patients. [1][2][3]5 The number of KTs performed has been rising gradually this decade. In 2019, 23 400 KTs were performed in the United States, which is 6300 more than the number of KTs recorded just 5 years ago. 6 As these numbers increase, care providers must be proactive in optimizing immunity against vaccine-preventable diseases since they are associated with high rates of morbidity and mortality post-transplantation. 7,8 Live attenuated vaccines, including the MMR vaccination, are not generally recommended in post-KT recipients since patients are on lifelong immunosuppression and are contraindicated. The AST Clinical Practice Guidelines advise that live virus vaccine serologic screening for MMR be conducted for all pre-KT candidates and MMR vaccinations be given if required as early as possible before KT procedure. 4

Serologic evaluation of vaccine preventable infections and vaccination rates in kidney transplant candidates

“…To our knowledge, this is first formal evaluation of baseline serologic status for MMR and VZV and vaccination rates in the KTC population. Ramakrishna and colleagues 5 examined the ability to specifically optimize MMR screening and vaccination in KTC. Seckin and colleagues 6 examined serologies and vaccine administration in heart, lung and liver candidates and highlighted an increased need for serologic evaluation and vaccination.…”

“…Vulnerability to vaccine‐preventable infections can lead to increased morbidity and mortality in solid organ transplant (SOT) recipients 1–6 . For example, measles can lead to severe complications in immunocompromised hosts including pneumonitis and encephalitis 7 .…”

“…recipients. [1][2][3][4][5][6] For example, measles can lead to severe complications in immunocompromised hosts including pneumonitis and encephalitis. 7 Varicella is associated with acute rejection episodes in pediatric renal transplants, with fewer severe cases reported in vaccinated individuals.…”

“…Vulnerability to vaccine‐preventable infections can lead to increased morbidity and mortality in solid organ transplant (SOT) recipients. 1 , 2 , 3 , 4 , 5 , 6 For example, measles can lead to severe complications in immunocompromised hosts including pneumonitis and encephalitis. 7 Varicella is associated with acute rejection episodes in pediatric renal transplants, with fewer severe cases reported in vaccinated individuals.…”

Vaccination in Kidney Transplant Candidates

“…The value of Infectious Disease consultation or structured programs for screening and catch-up immunization in improving vaccination rates among KT candidates have been demonstrated in other studies, and this was further strengthened by our study. 12,13,18-20 Vaccine acceptance rate was as high as 99% in 1 study, whereas in others, despite ID consultation or structured catch-up immunization programs, there was only a modest increase in immunization rates. 12,13,18,20 We did not have data on reasons for refusal except for a few patients.…”