Serostatus following live attenuated vaccination administered before pediatric liver transplantation

Area of Science:

• Immunology
• Pediatric Gastroenterology
• Hepatology

Background:

• Live attenuated vaccines (LAVs) are typically contraindicated post-liver transplantation (LT).
• Current guidelines recommend LAVs before LT for children aged ≥6 months, but supporting evidence is limited.
• Assessing the immunogenicity of LAVs in pediatric patients prior to LT is crucial for optimizing vaccination strategies.

Purpose of the Study:

• To evaluate the immunogenicity of LAVs administered before liver transplantation (LT) in pediatric patients.
• To identify factors associated with seronegativity following LAV administration in this cohort.
• To inform future vaccination guidelines for children undergoing LT.

Main Methods:

• Serum antibody titers were measured using hemagglutination inhibition and ELISA tests for measles, rubella, varicella, and mumps.
• Clinical data and vaccination history were collected from medical records of 49 patients.
• Univariate and multivariate analyses were performed to determine factors influencing serostatus.

Main Results:

• Seropositivity rates varied significantly: 46.9% for measles, 89.4% for rubella, 67.5% for varicella, and 48.8% for mumps.
• Factors associated with seronegativity included younger vaccination age (<12 months) for measles, lower body weight for varicella, and non-biliary atresia underlying diseases for mumps.
• No serious adverse events were reported during the study period.

Conclusions:

• The immunogenicity of LAVs before LT is robust for rubella but suboptimal for measles, varicella, and mumps.
• Current pre-LT vaccination protocols may require enhancement, particularly for certain vaccines and patient subgroups.
• Targeted serological follow-up is advisable for pediatric LT candidates with identified risk factors for vaccine non-response.