The Effect of Sirolimus Therapy on Vaccine Responses in Transplant Recipients

Willcocks, Lisa; Chaudhry, Afzal; Smith, J. Carson; Ojha, Shalini; Döffinger, Rainer; Cj, Watson; Smith, Kenneth G. C.

doi:10.1111/j.1600-6143.2007.01869.x

Cited by 44 publications

(38 citation statements)

References 20 publications

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“…In comparing different regimens, renal transplant patients on immunosuppression with mycophenolate had poorer seroprotective titers after influenza vaccination, compared with patients treated with azathioprine (5,8). Another randomized trial showed a trend toward higher seroresponse rates in patients who received sirolimus instead of calcineurin inhibitors (16).…”

Section: Discussionmentioning

confidence: 99%

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

Hurst¹,

Lee²,

Jindal³

et al. 2011

Clinical Journal of the American Society of Nephrology

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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.

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Section: Discussionmentioning

confidence: 99%

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

Hurst¹,

Lee²,

Jindal³

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…Effects of sirolimus have been assessed by Hayney et al, who found improved vaccine responses in lung recipients on sirolimus (41), and by Willcocks et al, who found similar rises in antibody titer between sirolimus-treated and calcineurin inhibitor-treated liver and kidney recipients, with sirolimus-treated patients developing protective titers to more influenza antigens (45).…”

Section: Influence Of Immunosuppressive Regimenmentioning

confidence: 99%

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

Kumar

Blumberg

Danziger‐Isakov

et al. 2011

American Journal of Transplantation

152

164

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Influenza virus causes a spectrum of illness in transplant recipients with a high rate of lower respiratory disease. Seasonal influenza vaccination is an important public health measure recommended for transplant recipients and their close contacts. Vaccine has been shown to be safe and generally well tolerated in both adult and pediatric transplant recipients. However, responses to vaccine are variable and are dependent on various factors including time from transplantation and specific immunosuppressive medication. Seasonal influenza vaccine has demonstrated safety and no conclusive evidence exists for a link between vaccination and allograft dysfunction. Annually updated trivalent inactivated influenza vaccines have been available and routinely used for several decades, although newer influenza vaccination formulations including high-dose vaccine, adjuvanted vaccine, quadrivalent inactivated vaccine and vaccine by intradermal delivery system are now available or will be available in the near future. Safety and immunogenicity data of these new formulations in transplant recipients requires investigation. In this document, we review the current state of knowledge on influenza vaccines in transplant recipients and make recommendations on the use of vaccine in both adult and pediatric organ transplant recipients.

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“…Several smaller studies addressing this issue in the past have yielded conflicting results (14)(15)(16)28).…”

Section: Scharpé Et Almentioning

confidence: 99%

Influenza Vaccination Is Efficacious and Safe in Renal Transplant Recipients

Scharpé¹,

Evenepoel²,

Maes³

et al. 2008

American Journal of Transplantation

148

131

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Whether influenza vaccination in solid-organ transplant recipients is efficacious remains a controversial issue. Furthermore, theoretical concerns have been raised regarding the safety of vaccination as it might trigger rejection of the allograft. The present prospective trial is aimed at investigating the antibody response and safety of influenza vaccination in renal transplant recipients (RTR).A total of 165 RTR and 41 healthy volunteers were vaccinated with a standard trivalent inactivated influenza vaccine. Hemagglutination-inhibiting (HI) antibodies were quantified before and 1 month after vaccination. Seroprotection (SP) and seroresponse (SR) were defined as a titer ≥40 and a 4-fold rise in HI titer, respectively. Similar SR rates were observed in both groups. Postvaccination SP rates in RTR amounted to 92.7%, 78.7% and 82.9% for A/H1N1, A/H3N2 and B, respectively. High baseline SP rates, most probably reflecting frequent preimmunizations, explain partly the high postvaccination SP rates. SR rate was independently and inversely associated with baseline SP rate. Mycophenolate mofetil (MMF) usage was associated with a 2.6-5-fold lower SR. Nonetheless, these patients showed good postvaccination SP rates. A booster dose did not enhance SP or SR rates. Influenza vaccination neither affected allograft function nor caused rejection episodes. In conclusion, influenza vaccination is efficacious and safe in renal transplantation.

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The Effect of Sirolimus Therapy on Vaccine Responses in Transplant Recipients

Cited by 44 publications

References 20 publications

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

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

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

Influenza Vaccination Is Efficacious and Safe in Renal Transplant Recipients

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