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World J Transplantation. Jan 16, 2019; 9(1): 1-13
Published online Jan 16, 2019. doi: 10.5500/wjt.v9.i1.1
Vaccinations in kidney transplant recipients: Clearing the muddy waters
Swati Arora, Gretchen Kipp, Nitin Bhanot, Kalathil K Sureshkumar
Swati Arora, Kalathil K Sureshkumar, Divisions of Nephrology and Hypertension, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA 15212, United States
Gretchen Kipp, Department of Pharmacy, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA 15212, United States
Nitin Bhanot, Infectious Diseases, Department of Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA 15212, United States
Author contributions: All authors contributed equally to this paper with literature search, drafting, editing, critical review and final approval of the manuscript.
Conflict-of-interest statement: No potential conflict of interest or financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Kalathil K Sureshkumar, MD, Associate Professor, Division of Nephrology, Department of medicine, Allegheny General Hospital, Allegheny Health Network, 320 East North Avenue, Pittsburgh, PA 15212, United States. ksureshk@wpahs.org
Telephone: +1-412-3593319 Fax: +1-412-3594136
Received: September 29, 2018
Peer-review started: September 29, 2018
First decision: October 16, 2018
Revised: November 13, 2018
Accepted: January 1, 2019
Article in press: January 1, 2019
Published online: January 16, 2019
Processing time: 109 Days and 17.4 Hours
Abstract

Vaccine preventable diseases account for a significant proportion of morbidity and mortality in transplant recipients and cause adverse outcomes to the patient and allograft. Patients should be screened for vaccination history at the time of pre-transplant evaluation and vaccinated at least four weeks prior to transplantation. For non-immune patients, dead-vaccines can be administered starting at six months post-transplant. Live attenuated vaccines are contraindicated after transplant due to concern for infectious complications from the vaccine and every effort should be made to vaccinate prior to transplant. Since transplant recipients are on life-long immunosuppression, these patients may have lower rates of serological conversion, lower mean antibody titers and waning of protective immunity over shorter period as compared to general population. Recommendations regarding booster dose in kidney transplant recipients with sub-optimal serological response are lacking. Travel plans should be part of routine post-transplant assessment and pre-travel vaccines and counseling should be provided. More studies are needed on vaccination schedules, serological response, need for booster doses and safety of live attenuated vaccines in this special population.

Keywords: Immunizations; Kidney transplant; Vaccines; Transplant outcomes; Serological response

Core tip: Vaccine-preventable disease can cause adverse patient and allograft outcomes in kidney transplant recipients. Patients should be screened for vaccinations pre-transplant and catch up immunization should be provided at least four weeks prior to transplantation. For non-immune patients, catch-up immunization should start six months post-transplantation. Live attenuated vaccines are contra-indicated in transplant patients. There is limited data that suggests safety of live vaccines in selective population on low immunosuppression. Travel plans should be part of routine post-transplant assessment and pre-travel vaccines and counseling should be provided.