Date: Sunday, April 30, 2017
Session Name: Poster Session B: Pediatric Liver Transplant - Clinical
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall D1
Background: Children listed for liver transplantation (LT) are at risk for decreased vaccine response due to age, underlying disease, or waning immunity. Live attenuated vaccines are currently contraindicated after LT.
Objective: This study aims to assess prevalence and risk factors of non-immunity to MMR and varicella in pediatric LT patients.
Methods: A retrospective chart review of pediatric LT patients followed at our institution with at least one documented dose of MMR and varicella vaccine and measles and varicella titers obtained after LT. Measles titers ≤25.0 AU/mL and varicella titers <135.0 IU were considered nonimmune. Variables assessed were sex, race, LT indication, age at LT, age at titer testing, WBC count, immunosuppression (levels, number of agents), nutritional status (BMI, weight/height, Vitamin D, albumin), prior viral or bacterial infection, histologically confirmed rejection or re-transplant. Variables compared for significance in univariate analysis and paired t-tests.
Results: 91 children met inclusion criteria. 25 (27%) were non-immune to measles and varicella, 14 (15%) nonimmune to measles only and 24 (26%) nonimmune to varicella alone. 28 (32%) were immune to both. Mean time from transplant to titer evaluation was 5.4 (±4.8) years. Significant results shown in tables 1, 2. Number of immunosuppressive agents, nutritional status, history of infection, rejection, or re-transplant did not correlate significantly with immune status, nor did biliary atresia, fulminant hepatic failure, or malignancy as indicators for LT.
|Variable||Measles Nonimmune (n=36)||Measles Immune (n=55)||P|
|Sex- M (%)||73||48.1||0.02|
|Age at LT (yrs)||1.8 (±2.3)||5.4 (±4.7)||<0.0001|
|Imm >15 mo (%)||9||81||<0.0001|
|Received booster (%) (n=13)||7||92||<0.0001|
|Tacrolimus lvl (ng/mL)||3.4 (±1.9)||5.02 (±3.6)||0.02|
|Variable||Varicella Nonimmune (n=50)||Varicella Immune (n=41)||P|
|Age at LT (yrs)||3.3 (±3.4)||5.6 (±5.5)||0.02|
|Age <15 mo at imm (%)||60||40||0.03|
|Indication for LT (%)- Metabolic disorder||30||12||0.04|
Conclusion: Male gender, young age at transplant, metabolic disorder and no receipt of booster prior to LT affect measles and/or varicella immune status in pediatric LT recipients. Further study into the immunogenicity and efficacy of live vaccines post-transplant is needed.
CITATION INFORMATION: Waugh A, Opekun A, Munoz F, Miloh T. MMR and Varicella Immunity After Pediatric Liver Transplant. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Waugh A, Opekun A, Munoz F, Miloh T. MMR and Varicella Immunity After Pediatric Liver Transplant. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/mmr-and-varicella-immunity-after-pediatric-liver-transplant/. Accessed November 26, 2020.
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