Influenza Vaccination Is Efficacious and Safe in Renal Transplant Recipients

Abstract

Whether influenza vaccination in solid-organ transplant recipients is efficacious remains a controversial issue. Furthermore, theoretical concerns have been raised regarding the safety of vaccination as it might trigger rejection of the allograft. The present prospective trial is aimed at investigating the antibody response and safety of influenza vaccination in renal transplant recipients (RTR).A total of 165 RTR and 41 healthy volunteers were vaccinated with a standard trivalent inactivated influenza vaccine. Hemagglutination-inhibiting (HI) antibodies were quantified before and 1 month after vaccination. Seroprotection (SP) and seroresponse (SR) were defined as a titer ≥40 and a 4-fold rise in HI titer, respectively. Similar SR rates were observed in both groups. Postvaccination SP rates in RTR amounted to 92.7%, 78.7% and 82.9% for A/H1N1, A/H3N2 and B, respectively. High baseline SP rates, most probably reflecting frequent preimmunizations, explain partly the high postvaccination SP rates. SR rate was independently and inversely associated with baseline SP rate. Mycophenolate mofetil (MMF) usage was associated with a 2.6-5-fold lower SR. Nonetheless, these patients showed good postvaccination SP rates. A booster dose did not enhance SP or SR rates. Influenza vaccination neither affected allograft function nor caused rejection episodes. In conclusion, influenza vaccination is efficacious and safe in renal transplantation.

Influenza A/H1N1 Vaccine in Patients Treated by Kidney Transplant or Dialysis

“…Among RT patients, those receiving mycophenolic acid had a lower increase in Ab response than those receiving azathioprine. This observation is similar to previous reports pertaining to influenza vaccination (9,11,26). This work brings additional data supporting the safety of influenza vaccination in renal transplant recipients (8,33) and also documents that vaccination does not induce sensitization against HLA or MICA in dialyzed patients, who can become candidates for kidney transplantation.…”

“…De novo HLA sensitization was recorded in only two patients (1.1%), a proportion even lower than the 4.8% reported by Candon et al (8). Our findings are in line with other recent publications that did not report an increase in acute rejection rates triggered by vaccination (8,9,34). Similar to HLA sensitization, the prevalence of MICA Abs remained stable after vaccination, and the frequency of de novo MICA sensitization was lower than 5%.…”

“…Further trials with higher vaccine doses and/or a booster may be warranted in these populations (9,35). …”

“…Either a single dose of 3.75 g of adjuvanted or 15 g of nonadjuvanted vaccine resulted in sero-conversion in approximately 75% to 90% of healthy volunteers (6,7). In solid organ recipients (8)(9)(10)(11) and dialysis patients (12), the overall rate of seroconversion to the seasonal flu vaccine is in the range of 30% to 50%. The use of adjuvanted vaccine has raised concerns for immunocompromised patients, because of possible induction of allo-immune responses, such as anti-human histocompatibility leukocyte antigen (HLA) antibodies (Abs) or MHC class I-related chain A (MICA) Abs (13)(14)(15)(16).…”

Efficacy and safety of the H1N1 monovalent vaccine in renal-transplant recipients and dialysis patients

“…15 In RTRs, the immune response can be decreased in all patients, 16 or only in patients receiving cyclosporine 17 or mycophenolate mofetil therapy. 18,19 However, the immune response to influenza vaccination has been described as adequate, 20,21 whereas the sero-response to hepatitis B or pneumococcal vaccination after transplantation and dialysis appears to be poor. [21][22][23] The time interval between transplantation and trivalent influenza vaccination has been shown to affect serologic response.…”