Human Papillomavirus Vaccination in Male and Female Adolescents Before and After Kidney Transplantation: A Pediatric Nephrology Research Consortium Study

Abstract

Background: Kidney transplant (KT) recipients have higher incidence of malignancies, including Human Papillomavirus (HPV)-associated cancers. Thus, HPV vaccines may have an important role in preventing HPV-related disease in this population; however, immunogenicity and safety data are lacking. Objective: To examine the immunological response and tolerability to HPV vaccination in pediatric KT recipients compared to future KT candidates. Methods: The quadrivalent HPV vaccine was administered to girls and boys age 9-18 recruited from seven centers part of the Pediatric Nephrology Research Consortium. Subjects were recruited for three groups: (1) CKD: chronic kidney disease stages 3, 4, and 5 not on dialysis; (2) Dialysis; (3) KT recipients. The outcome consisted of antibody concentrations against HPV 6, 11, 16, and 18. Geometric mean titers (GMTs) and seroconversion rates were compared. Vaccine tolerability was assessed. Results: Sixty-five participants were recruited: 18 in the CKD, 18 in the dialysis, and 29 into the KT groups. KT patients had significantly lower GMTs after vaccination for all serotypes. The percentages of subjects who reached seroconversion were overall lower for the KT group, reaching statistical significance for HPV 6, 11, and 18. Comparing immunosuppressed subjects (anyone taking immunosuppression medications, whether KT recipient or not) with the non-immunosuppressed participants, the former had significantly lower GMTs for all the HPV serotypes and lower seroconversion rates for HPV 6, 11, and 18. KT females had higher GMTs and seroconversion rates for certain serotypes. There were no adverse events in either group. Conclusions: HPV vaccine was well-tolerated in this population. Pediatric KT recipients had in general lower GMTs and seroconversion rates compared to their peers with CKD Nailescu et al. HPV Vaccination in Pediatric Nephrology or on dialysis. Immunosuppression played a role in the lack of seroconversion. Our results emphasize the importance of advocating for HPV vaccination prior to KT and acknowledge its safety post transplantation. Future studies are needed to investigate the effect of a supplemental dose of HPV vaccine in KT recipients who do not seroconvert and to evaluate the long-term persistence of antibodies post-KT.

Immunogenicity and Safety of the 9-Valent Human Papillomavirus Vaccine in Solid Organ Transplant Recipients and Adults Infected With Human Immunodeficiency Virus (HIV)

“…The observed seroconversion rates and GMTs in SOT patients are noticeably lower compared to data from 16 to 26 year old healthy adults [7][8][9][10]. So far, only four studies have reported the immunogenicity of HPV vaccines in SOT patients, and all concerned the qHPV vaccine [14,[26][27][28].…”

Promoting safe sexual practices and sexual health maintenance in pediatric and young adult solid organ transplant recipients

“…77 , and noted vaccine safety in all groups. 90,93 However, receipt of systemic immunosuppressive therapies was associated with significant decrease in seroconversion and geometric titers for each vaccine serotype tested; this difference was most apparent in the transplant recipient group with 69%-89% seroconversion. 93 Optimally, all efforts should be made to provide the 3-dose HPV vaccine series prior to transplantation.…”

“…90,93 However, receipt of systemic immunosuppressive therapies was associated with significant decrease in seroconversion and geometric titers for each vaccine serotype tested; this difference was most apparent in the transplant recipient group with 69%-89% seroconversion. 93 Optimally, all efforts should be made to provide the 3-dose HPV vaccine series prior to transplantation. However, if unable to be completed, the remaining doses can be completed starting 3-6 months after transplant; although immunogenicity will be less robust post-SOT when compared with individuals pre-SOT or those who are not immunocompromised, there is an ongoing benefit.…”

“…The HPV vaccine is safe and immunogenic in SOT recipients, including adolescent SOT recipients with immunogenicity dependent on type of vaccine, patient age, timing of vaccine delivery after SOT, type of transplant, and may vary by HPV serotype 90‐92 . A recent Pediatric Nephrology Research Consortium study evaluated HPV quadrivalent vaccine safety and seroconversion rates among 65 male and female subjects 9‐18 years old with chronic kidney disease, including kidney transplant recipients (n = 29), and noted vaccine safety in all groups 90,93 . However, receipt of systemic immunosuppressive therapies was associated with significant decrease in seroconversion and geometric titers for each vaccine serotype tested; this difference was most apparent in the transplant recipient group with 69%‐89% seroconversion 93 .…”

“…A recent Pediatric Nephrology Research Consortium study evaluated HPV quadrivalent vaccine safety and seroconversion rates among 65 male and female subjects 9‐18 years old with chronic kidney disease, including kidney transplant recipients (n = 29), and noted vaccine safety in all groups 90,93 . However, receipt of systemic immunosuppressive therapies was associated with significant decrease in seroconversion and geometric titers for each vaccine serotype tested; this difference was most apparent in the transplant recipient group with 69%‐89% seroconversion 93 . Optimally, all efforts should be made to provide the 3‐dose HPV vaccine series prior to transplantation.…”