*Purpose: The aim of this study was to identify missed opportunities for high-dose (HD) influenza vaccination among solid organ transplant (SOT) recipients and improve influenza vaccine administration within our institution.

*Methods: We reviewed all cases of confirmed influenza among SOT recipients identified between October 2018 and May 2019 at our center. Influenza cases were confirmed by Biofire Filmarray Respiratory Panel or Cepheid Xpert Flu/RSV panel.

*Results: A total of 14 SOT recipients had positive influenza testing, including 11 kidney, 2 liver and 1 heart transplant recipients. The rates of influenza were 1.4%, 0.4% and 2.2% percent among kidney, liver and heart transplant recipients respectively. Among kidney SOT recipients diagnosed with influenza, only 50% of patients were vaccinated during the flu season. All liver SOT recipients diagnosed with influenza were vaccinated. None of the liver or kidney SOT recipients received the recommended HD vaccine. The sole heart SOT recipient diagnosed with influenza was appropriately vaccinated with the HD vaccine. We identified 5 missed opportunities for vaccination despite 4 or more clinic visits during flu season. In addition, 6 patients received the inappropriate flu vaccine dose.

*Conclusions: Our data highlight the need for systematic vaccination assessments for all transplant candidates and recipients to prevent influenza infection. Additionally, it highlights the need for improved provider education of appropriate vaccination doses for this patient population among both transplant and non-transplant professionals who may administer the influenza vaccine.

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