Influenza vaccination during the first 6 months after solid organ transplantation is efficacious and safe

Abstract

Preventing influenza infection early after transplantation is essential, given the disease's high mortality. A multicentre prospective cohort study in adult solid organ transplant recipients (SOTR) receiving the influenza vaccine during four consecutive influenza seasons (2009-2013) was performed to assess the immunogenicity and safety of influenza vaccination in SOTR before and 6 months after transplantation. A total of 798 SOTR, 130 of them vaccinated within 6 months of transplantation and 668 of them vaccinated more than 6 months since transplantation. Seroprotection was similar in both groups: 73.1% vs. 76.5% for A/(H1N1)pdm (p 0.49), 67.5% vs. 74.1% for A/H3N2 (p 0.17) and 84.2% vs. 85.2% for influenza B (p 0.80), respectively. Geometric mean titres after vaccination did not differ among groups: 117.32 (95% confidence interval (CI) 81.52, 168.83) vs. 87.43 (95% CI 72.87, 104.91) for A/(H1N1)pdm, 120.45 (95% CI 82.17, 176.57) vs. 97.86 (95% CI 81.34, 117.44) for A/H3N2 and 143.32 (95% CI 103.46, 198.53) vs. 145.54 (95% CI 122.35, 174.24) for influenza B, respectively. After adjusting for confounding factors, time since transplantation was not associated with response to vaccination. No cases of rejection or severe adverse events were detected in patients vaccinated within the first 6 months after transplantation. In conclusion, influenza vaccination within the first 6 months after transplantation is as safe and immunogenic as vaccination thereafter. Thus, administration of the influenza vaccine can be recommended as soon as 1 month after transplantation.

Effect of Influenza Vaccination Inducing Antibody Mediated Rejection in Solid Organ Transplant Recipients

“…Different strategies can be used to increase vaccination efficacy such as the use of an adjuvanted vaccine that has been demonstrated to be safe inducing a protective immune response in SOTR ( 11 , 12 ). Our group demonstrated that having detectable antibody titers at vaccination improves the response to vaccination in SOTR supporting the administration of a booster dose of the influenza vaccine ( 13 , 14 ), that was later demonstrated to be safe and effective inducing an increased antibody response in a clinical trial ( 15 ).…”

“…A recent study has shown no cross-reactivity between HLA class I and II and several virus-specific human monoclonal antibodies, suggesting that the emergence of anti-HLA antibodies in the setting of viral infections or vaccination may be due to bystander activation or dormant HLA specific B cells ( 28 ). Our group has demonstrated that administering the influenza vaccine 1 month post-transplantation is safe and efficacious ( 14 ), reporting no episodes of rejection, however, we did not address the de novo synthesis of DSA.…”

Infektionen unter Immunsuppression nach Nierentransplantation

“…Eine Ausnahme stellt die saisonale Influenzaimpfung dar, deren Gabe bereits einen Monat nach NTx erfolgen kann. Die Impfung ist auch in den ersten 6 Monaten nach NTx sicher und effizient sowie vergleichbar mit der Gabe nach 6 Monaten [28]. Die Serokonversionsrate ist mit 15-90 % niedriger als in der Allgemeinbevölkerung.…”

Seasonal influenza vaccine in immunocompromised persons

“…61,62 However, a more recent prospective cohort study on 798 SOT recipients who were vaccinated before and after six months (130 vs. 668 respectively) after kidney, heart, and liver transplantation showed similar seroprotective immune response and safety profiles in both groups. 63 Therefore, it may be reasonable to administer influenza vaccine as soon as one month after transplantation.…”