Vaccinations, response, and controls before and after intestinal transplantation in children
Z Demir1, P Frange2,3,4, F Lacaille1
1Pediatric Hepato-Gastro-Enterology-Nutrition Unit, Necker-Enfants Malades Hospital, Paris, France.
Insights
Vaccinations are crucial for children post-intestinal transplant to prevent infections. Immunosuppression and antirejection therapy can reduce vaccine effectiveness, necessitating booster shots and adherence to schedules.
Area of Science:
- Pediatric Gastroenterology
- Transplant Immunology
- Infectious Diseases
Background:
- Children undergoing intestinal transplantation require intensive immunosuppression, increasing their susceptibility to infections.
- Maintaining immunity through vaccination is vital for this high-risk pediatric population.
Purpose of the Study:
- To assess vaccination schedules and antibody levels against vaccine-preventable diseases in pediatric intestinal transplant recipients.
- To identify factors influencing serological immunity and disease incidence post-transplantation.
Main Methods:
- Retrospective review of vaccination schedules in 22 pediatric intestinal transplant recipients.
- Analysis of antibody titers before and at 1 and 5 years post-transplantation.
- Correlation of antibody status with immunosuppression, antirejection therapy, and disease incidence.
Main Results:
- All patients completed primary vaccination schedules for DTaP-IPV and HBV.
- Reduced antibody levels post-transplantation were associated with antirejection therapy for DTaP-IPV, HBV, HAV, MMR, and VZV.
- Varicella infection occurred in 50% of unvaccinated children and was linked to acute rejection episodes.
- Waning immunogenicity necessitates post-transplant booster vaccinations.
Conclusions:
- Routine immunization schedules are insufficient for immunocompromised pediatric transplant recipients.
- Antirejection therapy significantly impacts vaccine-induced immunity, requiring careful monitoring and potential revaccination.
- Pre-transplant vaccination and post-transplant booster strategies are essential for managing vaccine-preventable diseases in this population.
Abstract:
Vaccination is an effective strategy to decrease infections in transplant recipients. Children after intestinal transplantation carry a high risk of infection due to increased immunosuppression. In a series of 22 children after intestinal transplantation, we studied the vaccination schedules and the antibodies against vaccine-preventable diseases before transplantation, and at one and five yr after transplantation. We reviewed whether the vaccination schedules were complete, and we analysed the factors that may influence serological immunity and the incidence of disease in patients with deficient immunity. All patients completed the recommended vaccination schedules for DTaP-IPV and HBV. After transplantation, the negative antibodies against vaccine-preventable diseases were mostly related to an antirejection therapy: for DTaP-IPV: four of four patients with no antibody had been treated for rejection, for HBV: two of five, HAV: three of four, MMR: three of seven, and VZV: three of four. A post-transplantation varicella infection was followed by acute rejection, with probability for a relationship between both events. We observed 50% of varicella cases in unvaccinated children, highlighting the importance of pretransplant vaccination. Waning immunogenicity mediated by antibodies against vaccine-preventable disease after transplantation indicated a need for boosters. The recommendations should be regularly enforced, as the reliance on routine immunizations schedules is not adequate in immunocompromised patients.
