Long-Term Immunological Effects of ATG Induction - 5 Year Results of a Prospective Renal Transplant Study

Live vaccines after pediatric solid organ transplant: Proceedings of a consensus meeting, 2018

“…CMV infection that requires antivirals can be a sign of underlying T‐cell dysfunction, and as such, live vaccine should be held until episode resolved. T cell–depleting agents have persistent immunologic effects lasting 1‐2 years such that live vaccinations are recommended to be deferred until the stated time period has elapsed—1 year after receipt of ATG and 2 years after receipt of alemtuzumab . Novel biologic agents, for example, obinutuzumab, are increasingly being used for various indications in pediatric transplantation, and until long‐term data regarding immune reconstitution after use of such agents are available, we recommend deferring live vaccination in these recipients …”

“…ATG is a polyclonal antibody that depletes T cells in peripheral blood and to some extent lymphoid tissue. Long‐term immunologic studies of patients who receive ATG indicate immune abnormalities persist up to 1‐2 years after administration specifically with regard to T‐cell function (proliferative capacity and cytokine production) . Thus, if ATG has been given in the past 24 months, further immunologic investigation is warranted prior to live vaccination, and live vaccination should be deferred if given less than 12 months ago.…”