Immunogenicity of Pneumococcal Vaccine in Renal Transplant Recipients—Three Year Follow‐up of a Randomized Trial

Abstract

Routine pneumococcal vaccination is recommended at regular intervals posttransplant. However, there is limited data on durability of vaccine response and the impact of vaccine type on antibody persistence. We determined the durability of response for patients enrolled in a randomized trial of conjugate (PCV7) versus polysaccharide (PPV23) pneumococcal vaccination. Response was defined as a twofold increase from baseline and a titer ≥0.35 lg/mL using a pneumococcal ELISA for seven serotypes (measured at 8 weeks and 3 years). Forty-seven patients were evaluated and had received either PPV23 (n = 24) or PCV7 (n = 23). Response rates and geometric mean titers varied by serotype but declined significantly at 3-years for 6 of 7 serotypes (p < 0.001). No significant difference in durability was found in patients that had received PPV23 versus PCV7. Compared to the 8-week response, 20.6% fewer patients had a response to at least one serotype by 3 years. The largest relative declines were seen for serotype 4 (response dropped from 40.4% at 8 weeks to 17.0% at 3 years) and serotype 9V (44.7% dropping to 21.3%). The only factor predictive of response durability was a strong multiserotype initial response (p < 0.001). In conclusion, vaccine responses decline significantly by 3 years and conjugate vaccine does not improve the durability of response.

Long-term persistence of the immune response to antipneumococcal vaccines after Allo-SCT: 10-year follow-up of the EBMT-IDWP01 trial

“…13 In kidney transplant patients vaccinated a mean of 1.2 years after transplant with either one dose of PCV7 or one dose of PPV23, the specific antibody levels had significantly decreased 3 years later, especially for pn4 and pn9V, and the durability of the response did not depend on the type of the vaccine but only on the level of the initial response. 14 In HSCT patients, due to the lack of data in the literature, the more recent guidelines do not give any recommendation on antipneumococcal immunization after 12 months posttransplant. 5 Our study is the first with a long follow-up of an homogeneous cohort of patients vaccinated 10 years ago according to the current guidelines.…”

Immunization in cancer patients: Where we stand

“…In the immunocompromised populations, this decline should be more frequent and more important, although precise data are lacking. After antipneumococcal vaccination in renal transplant recipients, it has been shown that one of the main determinant of the durability of the response is the level of the immediate immune response, rather than the type of the vaccine [31]. Individual assessments of vaccine-specific antibodies could certainly help for deciding to revaccinate, but these tests are not routinely available in many centers.…”

Immunizations for renal transplant candidates and recipients

“…44 Because boosting is more effective in patients who are immunized before transplantation, all transplant candidates should undergo pneumococcal vaccination. 46 Furthermore, the American Society of Transplantation recommends routine pneumococcal vaccination every 3-5 years. 12 …”