Varicella vaccination in pediatric kidney and liver transplantation

Prelog, Martina; Zimmerhackl, Lothar Bernd

doi:10.1111/j.1399-3046.2009.01204.x

Cited by 35 publications

(18 citation statements)

References 77 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Vaccination of SOT recipients with live-attenuated viral vaccines remains controversial and is clinical studies are currently limited to paediatric SOT recipients [92]–[94]. Generally, live vaccines are contraindicated in immunocompromised recipients as there is a risk of vaccine-virus replication.…”

Section: Discussionmentioning

confidence: 99%

Serologic Vaccination Response after Solid Organ Transplantation: A Systematic Review

et al. 2013

View full text Add to dashboard Cite

BackgroundInfectious diseases after solid organ transplantation (SOT) are one of the major complications in transplantation medicine. Vaccination-based prevention is desirable, but data on the response to active vaccination after SOT are conflicting.MethodsIn this systematic review, we identify the serologic response rate of SOT recipients to post-transplantation vaccination against tetanus, diphtheria, polio, hepatitis A and B, influenza, Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitides, tick-borne encephalitis, rabies, varicella, mumps, measles, and rubella.ResultsOf the 2478 papers initially identified, 72 were included in the final review. The most important findings are that (1) most clinical trials conducted and published over more than 30 years have all been small and highly heterogeneous regarding trial design, patient cohorts selected, patient inclusion criteria, dosing and vaccination schemes, follow up periods and outcomes assessed, (2) the individual vaccines investigated have been studied predominately only in one group of SOT recipients, i.e. tetanus, diphtheria and polio in RTX recipients, hepatitis A exclusively in adult LTX recipients and mumps, measles and rubella in paediatric LTX recipients, (3) SOT recipients mount an immune response which is for most vaccines lower than in healthy controls. The degree to which this response is impaired varies with the type of vaccine, age and organ transplanted and (4) for some vaccines antibodies decline rapidly.ConclusionVaccine-based prevention of infectious diseases is far from satisfactory in SOT recipients. Despite the large number of vaccination studies preformed over the past decades, knowledge on vaccination response is still limited. Even though the protection, which can be achieved in SOT recipients through vaccination, appears encouraging on the basis of available data, current vaccination guidelines and recommendations for post-SOT recipients remain poorly supported by evidence. There is an urgent need to conduct appropriately powered vaccination trials in well-defined SOT recipient cohorts.

show abstract

Section: Discussionmentioning

confidence: 99%

Serologic Vaccination Response after Solid Organ Transplantation: A Systematic Review

et al. 2013

View full text Add to dashboard Cite

show abstract

“…All patients who are seronegative must be vaccinated before transplantation. The live-attenuated vaccine is safe and gives persisting immunity to chickenpox, even if cases of disease are described in immunocompromised patients that had received the vaccine [66]. …”

Section: Prevention Of Infectionmentioning

confidence: 99%

Non-viral infections in children after renal transplantation

Mencarelli

Marks

2012

Pediatr Nephrol

View full text Add to dashboard Cite

Renal transplantation has long been recognised as the gold standard treatment for children with end-stage renal failure. There has been an improvement over the years in patient and renal allograft survival because of improved immunosuppression, surgical techniques and living kidney donation. Despite reduced acute allograft rejection rates, non-viral infections continue to be a serious complication for paediatric renal transplant recipients (RTR). The risk of infections in RTR is determined by the pre-transplantation immunisation status, post-transplant exposure to potential pathogens and the amount of immunosuppression. The greatest risk of life-threatening and Cytomegalovirus infections is during the first 6 months post-transplant owing to a high immunosuppressive burden. The potential sources of bacterial infections are donor derived, transplant medium fluid, peritoneal and haemodialysis catheter and transplant ureteric stent. Urinary tract infections are frequent in patients with lower urinary tract dysfunction and can result in renal allograft damage. This review outlines the incidence, timing, risk factors, prevention and treatment of non-viral infections in paediatric RTR by critically reviewing current immunosuppressive regimens, their risk–benefit ratio in order to optimise renal allograft survival with reduced rates of rejection and infectious complications.

show abstract

“…Generally, VZV vaccination in patients with chronic kidney or liver impairment listed for transplantation appears to be safe and in most cases efficient [75]. Experience with VZV vaccination after renal [76] or liver transplantation [77,78] is poor.…”

Section: Discussionmentioning

confidence: 99%

Aciclovir and Varicella-zoster-immunoglobulin in solid-organ transplant recipients

2010

Self Cite

View full text Add to dashboard Cite

Clear recommendations for the management of acute varicella-zoster virus (VZV) infections for cases of significant exposure and the use of prophylactic drugs after solid-organ transplantation are missing due to the lack of evidence by prospective studies. Heterogeneity in patient groups, patient numbers, age groups, immunosuppressive regimens, timing, and dosage of aciclovir and/or varicella-zoster immunoglobulin (VZIG), pre-transplant vaccination or VZV wild-type infection and inconsistency of data make comparability of different studies impossible. Although the benefit of aciclovir and/or VZIG is uncertain in immunosuppressed children, prospective controlled double-blind studies are not feasible for ethical considerations as fatal cases with disseminating varicella disease are well known in these patient groups despite the use of aciclovir and/or VZIG, whereas severe side-effects of these drugs are rare. However, a reporting bias is likely as mainly severe or fatal cases might have been predominantly published or cases of successfully used aciclovir and/or VZIG in mild cases or in cases of breakthrough infections after vaccination. As neither VZIG prophylaxis nor treatment with intravenous aciclovir offers complete protection against severe VZV infection to immunosuppressed pediatric solid-organ transplant recipients, high priority should be given to vaccination against VZV prior to transplantation, and, most importantly, in their close contact persons. Clinical observations suggest that only assessment of humoral immunity together with cellular immunity may allow predication about protection in exposed patients.

show abstract

Varicella vaccination in pediatric kidney and liver transplantation

Cited by 35 publications

References 77 publications

Serologic Vaccination Response after Solid Organ Transplantation: A Systematic Review

Serologic Vaccination Response after Solid Organ Transplantation: A Systematic Review

Non-viral infections in children after renal transplantation

Aciclovir and Varicella-zoster-immunoglobulin in solid-organ transplant recipients

Contact Info

Product

Resources

About