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Response to diphtheria and tetanus booster vaccination in pediatric renal transplant recipients
B U Enke1, A Bökenkamp, G Offner
1Children's Hospital, Hannover Medical School, Germany.
Insights
Diphtheria and tetanus booster vaccinations are safe and effective for pediatric renal transplant recipients, eliciting protective antibody levels comparable to healthy children. Immunization did not impact kidney function.
Area of Science:
- Immunology
- Pediatric Nephrology
- Transplantation Medicine
Background:
- Limited data exists on diphtheria and tetanus immunization efficacy and safety in immunocompromised patients, particularly pediatric renal transplant recipients.
- Standard inactivated vaccines are recommended for immunocompromised individuals, but specific responses in this population are understudied.
Purpose of the Study:
- To evaluate the immune response to a standard diphtheria and tetanus booster vaccination in pediatric renal transplant recipients.
- To assess the safety and efficacy of this immunization in this vulnerable patient group.
Main Methods:
- Forty-two pediatric renal transplant recipients (median age 13.2 years) with prior complete immunization received a diphtheria and tetanus booster.
- Antibody levels against diphtheria and tetanus were measured using enzyme-linked immunosorbent assay at baseline and 1, 6, and 12 months post-vaccination.
- Immunosuppressive regimens and allograft function were recorded and analyzed for their influence on antibody response.
Main Results:
- Pre-vaccination, 38% had protective diphtheria antibodies and 90% had protective tetanus antibodies.
- Post-booster, protection rates reached 95% for diphtheria (declining to 76% at 12 months) and remained complete for tetanus throughout the study.
- Antibody concentrations were comparable to those in healthy children, with no significant impact from immunosuppression, allograft function, or other clinical factors. Immunization was well-tolerated.
Conclusions:
- Diphtheria and tetanus booster vaccination is effective and safe in pediatric renal transplant recipients.
- The immune response is robust and comparable to healthy children, supporting current vaccination recommendations.
- This immunization strategy does not adversely affect kidney function in patients with stable allografts.
Background:
Although inactivated vaccines are recommended for immunocompromized patients, efficacy and safety of diphtheria and tetanus immunization in renal transplant recipients have received little attention so far. The aim of the study was to investigate the response to a standard diphtheria and tetanus booster vaccination in pediatric renal transplant recipients.
Methods:
Forty-two children, median age 13.2 years (range, 7.8-18.9 years) with complete primary immunization 9.2 years (0.9-15.4 years) before transplantation were enrolled. Immunosuppression consisted of cyclosporine plus prednisolone in 15 (36%), cyclosporine, azathioprine, and prednisolone in 24 (57%), and tacrolimus plus prednisolone in 3 (7%). Antibodies were measured by enzyme-linked immunosorbent assay before and 1, 6, and 12 months after vaccination.
Results:
Before vaccination, protective antibody concentrations exceeding 0.1 IU/ml against diphtheria were found in 16 children (38%). Thirty-eight (90%) had protective antibody concentrations against tetanus. After booster immunization, the protection rate against diphtheria rose to 95% at 1 month with a decline to 93% at 6 and 76% at 12 months. Protection against tetanus was complete after vaccination and persisted over the observation. Antibody concentrations were comparable to those reported for healthy children. Statistical analysis showed no influence of allograft function, immunosuppressive regimen, previous cytotoxic therapy, or time between primary immunization and end-stage renal failure on antibody response. Immunization was well tolerated and kidney function remained unaffected in patients with stable allograft function.
Conclusions:
Diphtheria and tetanus vaccination can be performed effectively and safely in renal transplant recipients as generally recommended.