Elimination of vaccine-preventable disease after solid organ transplantation (SOT) has the potential to improve outcomes. We evaluated immunization rates and the impact of directed recommendations as part of on-going quality improvement.

Records from 126 pediatric liver transplant (LT) recipients with annual visits from 8/2013-1/2014 were reviewed for two consecutive years during standardized annual visit planning. Immunization records from the hospital EHR, state databases and/or primary physician were reviewed. Immunization recommendations made by infectious diseases were communicated to the LT care team at least 1 month prior to the annual visit. Verbal and written recommendations were provided to the patients at the annual visit. We report immunization rates during the first two years of this effort including changes in immunization rates based on recommendations.

The patients were a mean of 3.1 years old (range 0-18.6 years) at transplant and 10.2 years post-transplant (1.9-25.2 years). 54% were female. Immunizations records were initially absent from the EHR in 26%. Immunizations were considered complete for HIB (95%), HepB (90%), Polio (83%), DTaP (including Tdap if indicated) (67%), HepA (48%), Meningococcus (32%), and Pneumococcus (conjugated 25%, polysaccharide 15%) at the first review. 118(93.7%) had at least one immunization recommended in the first year and only 4 followed all recommendations made by the second year. In the second year, recommended immunizations were received prior to annual visit planning for HIB (67%, 4 vaccinated/6 recommended), HepB (54%, 7/13), Polio (62%,13/21), Tdap (24%,10/42), HepA (55%, 36/64), meningococcus (40%, 34/86) and pneumococcus (conjugated 26%, 24/94; polysaccharide 16%, 17/107).

Vaccination is often incomplete after SOT. Review of immunizations records is essential to appreciate the depth of vaccine delay in pediatric LT recipients. Collection of information at a referral center requires additional steps. Education and recommendations are not sufficient to improve immunization rates despite review by knowledgeable provider and tailored recommendations. Further improvement measures are being assessed.

« Back to 2015 American Transplant Congress