Vaccinations for Adult Solid-Organ Transplant Recipients: Current Recommendations and Protocols

Abstract

Recipients of solid-organ transplantation are at risk of severe infections due to their life-long immunosuppression. Despite emerging evidence that vaccinations are safe and effective among immunosuppressed patients, most vaccines are still underutilized in these patients. The efficacy, safety, and protocols of several vaccines in this patient population are poorly understood. Timing of vaccination appears to be critical because response to vaccinations is decreased in patients with end-stage organ disease and in the first 6 months after transplantation. For these reasons, the primary immunizations should be given before transplantation, as early as possible during the course of disease. Vaccination strategy should include vaccination of household contacts and health care workers at transplant centers unless contraindicated. No conclusive data are available on the use of immunoadjuvants and screening for protective titers. Most vaccines appear to be safe in solid-organ transplantation recipients, but live vaccines should be avoided until further studies are available. The risk of rejection appears minimal. Recommended vaccines include pneumovax, hepatitis A and B, influenza, and tetanus-diphtheria. We outline specific protocols and recommendations in this particular patient population. Specific contraindications exist for other vaccines, such as yellow fever, oral polio vaccine, bacillus Calmette-Guerin, and vaccinia. We conclude that solid-organ recipients will benefit from consistent immunization practices. Further studies are recommended to improve established protocols in this patient population

Persistence of Yellow Fever Vaccine–Induced Antibodies After Solid Organ Transplantation

“…Tacrolimus and mycophenolate were administrated and she had no past history of graft rejection. Thus, in our study, the proportion of patients with no detectable YF antibodies was comparable to that of the general population, which is 6% at 1 year postvaccination (6,7,9). This proportion then increases to 21% between 11 and 38 years postvaccination (1,9).…”

“…To date, the only licensed vaccine against yellow fever (YF-17D vaccine) is a life-attenuated vaccine, which is contraindicated for immunocompromised people (5,6). SOT recipients, who are severely immunocompromised, should not be immunized with the YF-17D vaccine because the low-level viremia, frequently observed within 3-7 days postvaccination, is associated with a risk of fatal vaccineassociated disease (7).…”

Prevention of Infection in Lupus Patients

“…Although these vaccines have found to be generally safe and well tolerated by SLE patients, lupus-like syndrome and other autoimmune phenomena such as induction of lupus anticoagulants, anti-Ro/La and anti-smith antibodies have been reported following various immunizations [16]. Likewise, vaccinations may be less efficacious in SLE patients, as they have reduced primary and secondary immune responses upon antigenic challenge, in part due to immunosuppressive therapy [17,18].…”

“…Inactivated live vaccines are best avoided in patients receiving immunosuppressive agents, including glucocorticoids at daily doses over 20 mg. Live vaccines are contraindicated in SLE patients with active disease or on high-dose immunosuppressive therapy as they can result in infection [13,[15][16][17]. Many vaccines, including HPV, hepatitis B, pneumococcal vaccine, and influenza vaccine, have been shown to be immunogenic in the SLE population [18]. Although these vaccines have found to be generally safe and well tolerated by SLE patients, lupus-like syndrome and other autoimmune phenomena such as induction of lupus anticoagulants, anti-Ro/La and anti-smith antibodies have been reported following various immunizations [16].…”

Travel Medicine and the Solid Organ Transplant Recipient

“…The recommendations for routine immunization of immunocompromised individuals are available through the Centers for Disease Control and Prevention website (7); and other recent publications (8)(9)(10)(11)(12)(13) (14). (11,(15)(16)(17) (11,15,19 (30). (11,17,(31)(32)(33)(34).…”