Live virus vaccination following pediatric liver transplantation: Outcomes from two academic children’s hospitals

Abstract

Pediatric liver transplant (LT) recipients are often transplanted at a young age, precluding them from receiving live virus vaccinations (LVV) such as varicella (VZV) vaccine and measles, mumps and rubella. This places them at profound risk for vaccine preventable illness. We sought to detail safety of vaccination. This was a retrospective cohort study of pediatric LT recipients at two children's hospitals. Among 204 LT recipients included in the study, 97 received at least one LVV after LT. Six patients who did not receive LVV after transplant had evidence of vaccine‐preventable infection following vaccination (one disseminated VZV disease, five VZV‐related rash), while one patient who received LVV after transplant developed a diffuse VZV‐related rash. Rejection rates were the same between those that did and did not receive a live virus vaccine post‐transplant. There were no serious adverse events caused by vaccination post‐transplant. LVV following LT was safe at our two institutions, although there exist limitations in our study due to its retrospective study design. Larger scale studies should be performed to evaluate the effectiveness of LVV in relation to immunosuppression.

Live‐attenuated vaccination for measles, mumps, and rubella in pediatric liver transplantation

“…41,49,50 Therefore, cut-off levels for leukocytes >3000/μL, lymphocytes >1220/μL, IgG level >5 g/L, IgM level >0. but other prospective studies did not provide any equivalent information. 36,37,39 Table 2 summarizes the selection criteria used in vaccination trials in LT with MMR vaccines. Furthermore, even within the LIVE VAC study cohort, very large differences in eligibility criteria are found between the study centers.…”

Spotting a potential threat: Measles among pediatric solid organ transplantation recipients

“…Measles vaccination of severely immunocompromised individuals has been contraindicated since the 1960s, when in one study, 1 of 8 children with underlying leukemia received attenuated measles vaccine and died 3 months after vaccination, though autopsy histopathology did not confirm measles as the cause of death 92 . Recent studies have described the safety and immunogenicity of MMR in seronegative liver and kidney transplant recipients receiving low‐level immunosuppression who had not received two doses of a measles‐containing vaccine prior to SOT 93–100 . The American Society of Transplantation and proceedings from an expert consensus meeting have since published recommendations for MMR vaccination after SOT in certain pediatric kidney and liver recipients, based on available data 28,101 .…”

“…92 Recent studies have described the safety and immunogenicity of MMR in seronegative liver and kidney transplant recipients receiving low-level immunosuppression who had not received two doses of a measlescontaining vaccine prior to SOT. [93][94][95][96][97][98][99][100] The American Society of Transplantation and proceedings from an expert consensus meeting have since published recommendations for MMR vaccination after SOT in certain pediatric kidney and liver recipients, based on available data. 28,101 To be considered eligible for MMR vaccination post-SOT, the pediatric liver or kidney recipient should be clinically well, ≥1 year post-SOT, ≥2 months after any acute graft rejection treatment episode, and meet specific criteria for a "low-level" net state of immune suppression.…”

Live attenuated vaccines in patients receiving immunosuppressive agents

“…We identified 25 reports, including clinical research, case series, and case studies, on the use of live vaccines in patients receiving immunosuppressants [ 21 – 45 ]. Many of the patients involved had undergone solid organ transplants, and a large proportion were children (Table 3 ).…”