Improving Vaccinations in the Pediatric Transplant Population: 4-Year Quality Improvement Outcomes

An ongoing quality improvement process was used to increase live and inactivated vaccination rates among vaccine-eligible pediatric liver transplant patients.

We evaluated 4-year outcomes (2019-2023) of Plan-Do-Study-Act (PDSA) cycles to guide vaccine counseling and management for pediatric liver transplant recipients. The annual posttransplant visit was used to provide families education regarding live and inactivated immunizations and obtain antibody titers for varicella, measles, mumps, rubella, Haemophilus influenzae type b, hepatitis A and hepatitis B. Vaccine recommendations were based on clinical criteria determined by our multidisciplinary team. Recommendations were then communicated with families and primary care providers (PCPs). Immunizations were administered by PCPs. Titers were obtained 4 weeks following immunization to assess response.

Fifty-four patients met inclusion criteria. Recommendations for live (n = 38) and inactivated (n = 49) vaccines were given to patients. At the end of cycle 4, there was a notable increase in the number of patients who achieved protective titers to all live and inactivated vaccines in comparison to the start of cycle 1. The protective antibody titers to live vaccines declined in nearly half of our patients (n = 23/54, 43%), with the majority being to varicella vaccine and a smaller number to measles vaccine. However, most patients who were reimmunized (n = 13/14, 93%) had protective antibody titers following booster administration. There were no serious adverse effects to live vaccines.

We successfully recommended vaccinations and documented vaccine-induced immunity by implementing an active vaccine education and screening program. For PDSA cycle 5, we plan to continue our current practice and offer vaccines in transplant clinic, an identified barrier to vaccination.