Varicella-Zoster Immunization in Pediatric Liver Transplant Recipients: Safe and Immunogenic

Abstract

Varicella can have a severe course in immunosuppressed patients. Although prevention is fundamental, live-attenuated varicella-zoster (VZV) vaccine is not currently recommended in transplant recipients. Our aims were to (1) evaluate VZV immunity in pediatric liver transplant (LT) recipients; (2) immunize (two doses) seronegative patients post-LT; (3) monitor vaccine safety, (4) assess B and T cell vaccine responses. All patients followed at the Swiss National Pediatric LT Center were approached and 77/79 (97.5%) were enrolled (median age 7.8 years).

Updated data on effective and safe immunizations with live-attenuated vaccines for children after living donor liver transplantation

“…Self-limited swelling of the parotid glands after mumps immunization (3.9%, 2/51) was similar to the rate previously reported among healthy vaccinees (3.5%) [23]. Recent reports regarding immunization for post-liver transplant patients also showed no related serious adverse events [5][6][7][8].…”

“…The seroconversion rates were higher (measles), similar (rubella, varicella), or lower (mumps) than those in post-liver transplant patients in previous reports, although the total number of vaccinees varied: 41% (7/17) [4], 85% (11/13) [5], and 73% (19/26) [7] for measles; 100% (2/2) for rubella [5]; 71% (5/7) [5], 64.5% (20/31) [7], 87% (13/15) [6], and 100% (4/4) [8] for varicella; 100% (6/6) [5] for mumps. As explained above, only the recent seroconversion rate for the mumps Hoshino strain seemed unsatisfactory.…”

“…After OLT, the seroconversion rate can be lower, and theoretical risks of infection and rejection due to live vaccine viruses exist. There are few reports regarding immunization using live-attenuated vaccines after liver transplantation [3][4][5][6][7][8].…”

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

“…1 They are not recommended in adults after transplantation. Some data suggest that paediatric patients on low-dose immunosuppression after liver transplantation can safely and effectively undergo varicella vaccination, 33,34 but this finding has not been documented in adult transplant recipients and the vaccine is contraindicated in these patients. [3][4][5] Seronegative renal transplant recipients with exposure to varicella can be given acyclovir, vala cyclovir or famciclovir for prophylaxis, varicellaspecific immunoglobulin can also be used.…”

Impfungen bei Immundefekten/Immunsuppression – Expertenstatement und Empfehlungen

“…Hier wurde gezeigt, dass diese Impfung drei Jahre nach Transplantation sicher war und zu einer Seroprotektion geführt hat [83].…”