Influenza vaccination in solid-organ transplant recipients

We reviewed the most recent literature on solid-organ transplant (SOT) recipients regarding the clinical significance of influenza and the immunogenicity and safety of influenza vaccine in this population.

In SOT recipients, influenza is associated with significant graft dysfunction and even mortality. Early initiation of antiviral therapy is associated with a reduced risk for influenza-associated complications, mainly pneumonia. The main preventive strategy against influenza in SOT recipients remains the administration of yearly influenza vaccine. Although most studies have shown that influenza vaccination is safe after transplantation, impaired responses are expected in more immunosuppressed patients. A lower immunogenicity of influenza vaccine has been described in patients receiving mycophenolate and mammalian target of rapamycin inhibitors. The optimal timing of vaccination after transplant remains to be determined, although vaccination during the early posttransplant period appears to be safe. Novel vaccination strategies, such as intradermal vaccination or use of adjuvanted vaccines, have been evaluated in SOT recipients, with inconclusive results to date.

The administration of influenza vaccination is strongly recommended in SOT recipients and their relatives. Further research is needed for improving the immunogenicity of influenza vaccine in this population.