Outcomes Associated with Influenza Vaccination in the First Year after Kidney Transplantation

Abstract

Summary Background and objectives Influenza vaccination is recommended in all renal transplant recipients. However, immunosuppression in the early period post-transplant may attenuate the immunologic response to the vaccine. Additionally, it has been theorized that vaccination can induce an immune response that could trigger rejection episodes. Design, setting, participants, & measurements In a retrospective cohort of 51,730 adult Medicare primary patients who were first transplanted from January 2000 to July 2006 and followed through October 2006, we assessed Medicare claims for influenza vaccination and influenza infections, respectively. Outcomes included allograft loss and death. Results There were 9678 (18.7%) patients with claims for influenza vaccination in the first year post-transplant. Factors associated with vaccination included older age, diabetes, later year of transplant, and tacrolimus or mycophenolate at discharge. Vaccinations were less frequent among men, African Americans, highly sensitized patients, or those receiving induction immunosuppression or expanded criteria donor kidneys. Vaccination in the first year after transplant was associated with lower risk of subsequent allograft loss and death. Claims for influenza infection were reported in 310 (0.6%) patients and were not significantly associated with graft loss, although there was a trend toward death. Conclusions In the first year after renal transplantation, influenza vaccination was associated with a lower risk of subsequent allograft loss and death. Although this study cannot comment on formation of protective antibodies after vaccination, these data do not support withholding vaccination on the basis of concerns of adversely affecting allograft function.

B-Sides Serologic Markers of Immunogenicity in Kidney Transplanted Patients

“…Despite a safe profile being previously described in Tps vaccinated against influenza (12), this was elsewhere shown to stimulate a nonspecific humoral response leading to the production of anti-HLA antibodies (15,32,33). We also recently reported an increase of polyspecific (non-HLA) autoreactive antibodies (34) after vaccination in this same population.…”

Serological response to influenza A H1N1 vaccine (Pandemrix®) and seasonal influenza vaccine 2009/2010 in renal transplant recipients and in hemodialysis patients

“…So far, in this patient group, inXuenza vaccination has to be evaluated as safe [15] and bears the potential to prevent patients from serious inXuenza virus infection. Moreover, a recent study on renal transplant recipients revealed that inXuenza vaccination is associated with a lower risk of transplant loss and death in the 1 year after transplantation [24].…”

Immunization after kidney transplantation—what is necessary and what is safe?

“…In a retrospective cohort study of 51,730 adults who underwent first kidney transplantation between January 2000 and July 2006, 9,678 (18.7%) patients had Medicare claims for influenza vaccination in the first year after transplantation; influenza vaccination was associated with a lower risk of subsequent allograft loss and death. 18 Although this study did not evaluate serological response to vaccination, the data indicates that vaccines should not be withheld because of concerns that they might adversely affect allograft function.…”