Influenza vaccine after pediatric kidney transplant: a Midwest Pediatric Nephrology Consortium study

Abstract

The main aim of this study was to compare the response to trivalent inactivated influenza vaccine in children who received a kidney transplant and were on steroid-free versus steroid-based immunosuppression. Groups: 1. Kidney transplant recipients on steroid-free immunosuppression (n=27); 2. Kidney transplant recipients on steroid-based immunosuppression (n=39); 3. Healthy controls (n=21). Hemagglutination inhibition titers against 2007-2008 A/H1N1 and A/H3N2 and B strains were measured before and 8 weeks postvaccination. Postvaccination geometric mean titers to A/H1N1 were significantly lower among both transplant groups than controls (p=0.025 and 0.015, respectively). Postvaccination titers to H3N2 and B strains were not statistically different between groups. Proportions of participants developing seroprotection were not different among groups. Both kidney transplant groups seroconverted less than controls for A/H1N1 (p=0.0002) and were no different from controls for B. For A/H3N2, the steroid-free group had the weakest seroconversion (p=0.008), possibly due to mycophenolate-enhanced exposure and a younger age. Overall, children after kidney transplantation demonstrated a good serologic response to the inactivated influenza vaccine although somewhat lower than controls. Steroid-free immunosuppression did not seem to present an advantage in antibody response. Data on inactivated influenza vaccine safety and efficacy was collected and demonstrated absence of acute rejection or laboratory-proven influenza for 6 months postvaccination.

Serologic Vaccination Response after Solid Organ Transplantation: A Systematic Review

“…In total, 36 trials on inactivated trivalent influenza vaccination after SOT were included in the review with publication dates ranging from 1980 to 2011 and vaccines against the circulating strains of the influenza season of 1981/82 to 2007/2008 [13]–[15], [32]–[64].…”

Influenza Vaccination in the Organ Transplant Recipient: Review and Summary Recommendations

“…Similarly, recent reports in pediatric kidney transplant recipients show variable seroprotective responses ranging from 31% to 85% depending on the vaccine strain (65,66). In a cohort of children postliver transplant, Mack et al reported that younger age and shorter posttransplant time were factors for poorer vaccine response.…”

Prevention and Control of Seasonal Influenza with Vaccines

“…In one study, kidney transplant recipients who were 3-10 years posttransplant had a 93% seroprotection rate to A(H1N1) antigen after vaccination (232). Among persons with kidney or heart transplants, seroresponse rates were similar or slightly reduced compared with healthy persons (232)(233)(234)(235)(236)(237). However, a small study involving participants with liver transplants indicated a reduced immunologic response to influenza vaccinations (238).…”