Immune responsiveness and protective immunity after transplantation

Abstract

Summary The growing success of solid organ transplantation poses unique challenges for the implementation of effective immunization strategies. Although live attenuated vaccines have proven benefits for the general population, immunosuppressed patients are at risk for unique complications such as infection from the vaccine because of lack of both clearance and containment of a live attenuated virus. Moreover, while vaccination strategies using killed organisms or purified peptides are believed to be safe for immunosuppressed patients, they may have reduced efficacy in this population. The current lack of knowledge of the basic safety and efficacy of vaccination strategies in the immunosuppressed has limited the development of guidelines regarding vaccination in this population. Recent fears of influenza pandemics and potential attacks by weaponized pathogens such as smallpox heighten the need for increased knowledge. Herein, we review the current understanding of the effects of immunosuppressants on the immune system and the ability of the suppressed immune system to respond to vaccination. This review highlights the need for systematic, longitudinal studies in both humans and nonhuman primates to understand better the defects in innate and adaptive immunity in transplant recipients, thereby aiding the development of strategies to vaccinate these individuals.

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

“…Figure S1). In a single patient (1.6%) (10,26,(29)(30)(31)(32)(33). Furthermore, our data confirm and extend the results of the single study which analyzed postvaccinal HLA antibodies and showed that in heart transplant recipients no significant donor-specific allosensitization was induced by influenza vaccination (30).…”

Serological response to influenza A H1N1 vaccine (Pandemrix®) and seasonal influenza vaccine 2009/2010 in renal transplant recipients and in hemodialysis patients

“…On the other hand, it was hypothesized that inXuenza vaccination itself could trigger an allograft rejection. This assumption could not be proven in clinical studies [15,16]. So far, in this patient group, inXuenza vaccination has to be evaluated as safe [15] and bears the potential to prevent patients from serious inXuenza virus infection.…”

Immunization of children with secondary immunodeficiency

“…48 Moreover, after HSCT, the recovery of cellular immunity may require months or even years, and in the absence of re-immunization, antibody titers to pathogens for which vaccines had been administered decreases during the 1-10 years after HSCT. 49 Consequently, repeating the primary vaccine series after HSCT is critical to prevent life-threatening infections.…”