*Purpose: Pre-transplant live vaccination rates are suboptimal in pediatric patients with end-stage organ disease. Ensuring live vaccine administration prior to transplant (txp) confers the best opportunity for protection and should be a pre-txp goal. The aim of this study was to determine if a multidisciplinary team approach to immunization management impacted MMR and Varicella vaccination completion rates in pediatric transplant candidates.

*Methods: In January 2016, an immunization protocol was implemented in an effort to optimize vaccine administration to pediatric txp candidates. This included infectious disease referral as part of txp evaluation and pediatric txp pharmacist review of immunization record at txp evaluation and every 6 months until transplantation. This was a single center, retrospective cohort study of pediatric txp recipients who received a heart, kidney, or liver from 1/2013-9/2018. Patients > 18 yrs or < 6 mo of age at time of txp were excluded. Comparisons between pre- and post-intervention for live vaccination rates were done using multivariate logistic regression, controlling for patient sociodemographics.

*Results: 89 patients were included. Baseline demographics, including age, gender, and days on waitlist were similar between groups. There were more kidney recipients pre-intervention and more liver recipients post-intervention (Table 1). A multidisciplinary team approach towards vaccination increased the odds of completing both live vaccination series (MMR and Varicella) by 9-fold (95% CI 2.5-32.4, p=0.01). The intervention also increased the odds of patients completing either Varicella or MMR series by 7.8 and 6.3, respectively (95% CI 2.2-26.7, 1.6-24.2, p=0.001, 0.008). The odds of only receiving partial vaccinations were less post-intervention as more completed series occurred for both Varicella and MMR vaccinations (p=0.031, 0.01, Figure 1).

*Conclusions: These results demonstrate that this multidisciplinary intervention improved the completion of MMR and Varicella vaccine series for solid organ recipients prior to txp and could be a meaningful method to aid other centers.

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