Long-term study showed that vaccination protected paediatric renal transplant recipients from life-threatening
Jenny K Lindahl1,2, Vanda Friman1,2, Susanne Westphal Ladfors3,4
1Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden.
Insights
Varicella zoster virus (VZV) vaccination in pediatric renal transplant patients offers less protection against symptomatic VZV infections than natural infection but effectively prevents severe, life-threatening disease.
Area of Science:
- Immunology
- Pediatric Nephrology
- Transplantation
Background:
- Renal transplant recipients have compromised immunity, increasing susceptibility to infections like varicella zoster virus (VZV).
- Understanding VZV serology and infection outcomes in this vulnerable population is crucial for managing post-transplant complications.
Purpose of the Study:
- To assess the long-term VZV serology status in pediatric renal transplant recipients.
- To evaluate the clinical outcomes of VZV infections in vaccinated versus naturally infected children post-transplantation.
Main Methods:
- Retrospective study of 85 children undergoing renal transplantation in Gothenburg, Sweden (1986-2014).
- Analysis of medical records for pre-transplant VZV infection or vaccination status, clinical outcomes, and serology.
- Follow-up for a median of five years post-transplant.
Main Results:
- Pre-transplant VZV seropositivity was 94% in the infection group and 50% in the vaccination group.
- Post-transplant, 97% of the infection group and 28% of the vaccination group remained seropositive.
- Varicella occurred in 8 children (7 vaccinated, 1 infected); herpes zoster in 2 children (both infected).
Conclusions:
- VZV vaccination provides less protection against symptomatic VZV infections compared to natural VZV infection in pediatric renal transplant recipients.
- Despite lower symptomatic protection, VZV vaccination effectively prevents severe, life-threatening VZV disease in this immunocompromised group.
Aim:
Renal transplant patients are particularly susceptible to highly contagious diseases due to their reduced immunity. We studied transplant recipients to gauge their varicella zoster virus (VZV) serology status over time and the outcome of any VZV infections.
Method:
This retrospective study comprised 85 children who underwent renal transplants in Gothenburg, Sweden, from 1986 to 2014, at a mean age of eight (1-18) years. The children's medical records were reviewed and 47 had the VZV infection pre-transplant and 38 had been vaccinated pre-transplant. Clinical outcomes were available for 85 children and serology results for 72.
Results:
At transplantation, the VZV seropositivity rate was 50% in the vaccination group and 94% in the infection group and the antibody titres were significantly lower in the vaccination group (p = 0.031). During the median follow-up period of five years post-transplant, 28% of the vaccinated children and 97% of the infection group remained seropositive and the varicella infection affected eight children: one in the infection group and seven in the vaccination group. The herpes zoster was observed in two children in the infection group.
Conclusion:
This study demonstrated that VZV vaccination protected from symptomatic infections to a lesser extent than natural infection, but provided effective protection from life-threatening disease.
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