*Purpose: Vaccine preventable infections are a serious and common complication following transplant. Immunizations are a minimally invasive and cost-effective approach to reducing infections. The objectives of this study were to 1) quantify the percentage of patients at Society of Pediatric Liver Transplantation (SPLIT) centers who were up-to-date on age-appropriate immunizations at the time of transplant and 2) determine whether independent demographic factors (age, gender, race, ethnicity, diagnosis, center size and involvement of an infectious diseases physician in the transplant evaluation) were associated with under-immunization.

*Methods: We collected immunization records at the time of transplant for all children <18 years of age who underwent liver transplant (excluding those with acute liver failure) at a SPLIT center between August 2017-August 2018. Data were also collected on location where immunizations were administered, involvement of an infectious diseases physician in the transplant evaluation and need to delay transplant listing to allow for immunization delivery.

*Results: Of 301 subjects who underwent non-acute liver failure transplant at a SPLIT center during the study period, immunization records were available in 281 subjects (93%), representing 34 SPLIT centers (97% of centers which performed a transplant during the study period). Of the 301 subjects, 38% had biliary atresia, 17% had a metabolic disease, 11% had a tumor, and 34% had an alternative or missing diagnosis. Only 82 (29%) of subjects were completely up-to-date for age on immunizations using the Centers for Disease Control’s Standard Immunization Schedule. Only 52 (18%) of subjects were up-to-date on age-appropriate immunizations using the Infectious Diseases Society of America’s accelerated immunization schedule for transplant candidates. Of all subjects, only 5% were reported to have had delayed transplant listing to allow for immunization compliance. The majority (63%) received their immunizations solely at the primary care provider’s office. The most frequently missed immunizations were the Hib and pneumococcal immunizations. Of subjects 6-11 months of age at transplant (n=52) who were eligible to receive accelerated live immunizations, only 13 (25%) had received the measles-mumps-rubella immunization and 8 (15%) had received the varicella immunization. In univariate analysis, there were no unique demographic factors associated with under-immunization.

*Conclusions: The majority of pediatric liver transplant recipients are under-immunized at the time of transplantation. Subspecialists and primary care providers must work together to ensure these high-risk children receive immunizations.

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