Measles, Mumps, Rubella, and Varicella Zoster Virus Serology and Infections in Solid Organ Transplant Recipients During the First Year Posttransplantation

Abstract

Background Mumps, measles, rubella, and varicella zoster (MMRV) viruses may cause severe infections in seronegative adult solid organ transplant (SOT) recipients, but can be prevented by vaccination. We aimed to determine MMRV serostatus in adult SOT recipients before and 1 year after transplantation as well as evidence of MMRV infections in a large, prospective cohort of SOT recipients. Methods This was a prospective study of 1182 adult SOT recipients included in the Management of Posttransplant Infections in Collaborating Hospitals (MATCH) cohort from 2011 to 2017 with a 1-year follow-up. Systematic monitoring of MMRV serology was performed prior to transplantation and 1 year posttransplantation. Polymerase chain reaction (PCR) was used to confirm viral replication in SOT recipients presenting with clinical evidence of infection. Results Among 1182 adult SOT recipients, 28 (2.4%), 77 (6.5%), 65 (5.5%), and 22 (1.9%) were seronegative for measles, mumps, rubella, and varicella zoster virus (VZV), respectively, and 165 (14%) were seronegative for at least 1 of the MMRV viruses. One year posttransplantation, 29 of 823 (3.5%) of seropositive SOT recipients had seroreverted, and 63 of 111 (57%) of seronegative SOT recipients seroconverted for at least 1 MMRV virus. No evidence of measles, mumps, or rubella infection was found, but 8 (0.7%) SOT recipients developed symptoms and had a positive VZV PCR. Conclusions A large proportion of SOT recipients were seronegative for at least 1 of the MMRV viruses. MMRV infections in SOT recipients may disseminate and become fatal, and although only a few cases of VZV infection were detected, results from this study suggest increase attention toward vaccination of patients waiting for SOT.

Vaccination and their importance for lung transplant recipients in a COVID-19 world

“…as examples of absolute correlation towards clinical protection (i.e., seroprotection almost guarantees protection) [63]. In line with this, a study in Denmark has included lung transplant patients and analyzed serostatus prior to transplantation and one-year posttransplant [78]. Approximately 13% of lung transplant patients were seronegative to at least one of the MMR viruses prior to transplantation.…”

“…Among the recipients that remained seronegative for at least one year, 43% remained seronegative and 57% seroconverted during follow up. Additionally, lung transplant recipients were found to be more likely to seroconvert, which was hypothesized due to the transfer of antibodyproducing long-lived plasma cells from a seropositive donor lung [78]. It should be kept in mind that measles and mumps vaccines are live-attenuated and are therefore contraindicated after lung transplantation…”

Seroprevalence of Measles, Mumps, Rubella, and Varicella-Zoster Virus and Seroresponse to the Vaccinations in Adult Solid Organ Transplant Candidates

“…Another study from Denmark showed a higher seroprevalence of measles (95.3%), mumps (89%), rubella (90.7%), and VZV (96.3%) among 1182 SOT candidates. 11 These studies, including ours, identified younger age as a factor associated with seronegativity. 11,23 The timing of the introduction of MMR vaccines in individual countries (United States: 1971 24 and Denmark: 1987 25 ) could explain why elderly patients have higher seropositivity, which is likely caused by natural infection.…”

Transmitted Donor Immunology Not Infection: Common Persistence of Donor Hepatitis C Antibody Production in Aviremic Lung Transplant Recipients

“…The concept of the transfer of cells, cell fractions and molecules is increasingly recognized as a common feature of organ transplantation [3][4][5]19]. PLS is seen as an active form of this and has been seen as donor B cell production of antibodies against recipient antigens, typically against ABO antigens on red blood cells, leading to hemolytic anemia [6].…”

“…Koshizuka et al have also shown that donor-derived plasma cells transmitted in a lung allograft are capable of producing long lasting anti-cytomegalovirus antibodies [5]. Rezahosseini et al have extended this concept further with a recent paper noting that at 1 year post organ transplant 57% of seronegative recipients show seroconversion for at least one of measles, mumps or rubella viruses without clinical infection [19]. Put together these PLS case series make it quite likely that the current study is yet another PLS example-and does not represent recipient HCV infection perse.…”