Purpose:

Prevention of systemic viral and bacterial infections by effective vaccination in kidney allograft recipients is of vital importance, but data on the vaccination status in pediatric patients are scarce.

Methods:

In the framework of the Cooperative European Paediatric Renal Transplant Initiative (CERTAIN) Registry, we therefore performed a multicenter, cross-sectional study in 254 patients (mean age 10.0 ± 5.6 years) and analyzed their vaccination status and titers before and after renal transplantation (RTx).

Results:

Only 2/3 of patients had a complete country- and era-specific vaccination status for most vaccines prior to RTx. In particular, the vaccination rate against human papillomavirus (HPV) (27.3%), pneumococcal (42.2%) and meningococcal (47.9%) infections was low. As few as 58.1% of patients developed a hepatitis B titer (HBsAb titer) > 100 I.U./L before RTx. 39.6% of patients showed a secondary vaccination titer loss post-transplant, especially against the life-virus vaccines varicella and mumps as well as the inactivated vaccines tetanus, diphtheria, pneumococcus and hepatitis B. Patients with a HBsAb titer between 10 and 100 I.U./L prior to RTx experienced significantly (p < 0.05) more often a hepatitis B vaccination titer loss post-transplant than patients with a HBsAb titer > 100 I.U./L prior to RTx. The revaccination rate post-transplant was low and failed to induce protective titers in a considerable amount of patients: only 37.5% developed a sufficient HBsAb titer, and as few as 14.3% of patients showed a protective pertussis titer after revaccination.

Conclusions:

The vaccination coverage rate of CKD patients prior to RTx is insufficient, particularly against HPV, pneumococcal and meningococcal infections. Recommended revaccinations post-transplant are performed deficiently. Given the rate of secondary vaccination titer loss after RTx, the recommendations of the American Society of Transplantation to measure vaccination titers against tetanus, hepatitis B and pneumococcus at regular intervals post-transplant should be followed in order to induce timely revaccination and thus avoid the development of vaccine-preventable diseases.

CITATION INFORMATION: Höcker B, Aguilar M, Schnitzler P, Pape L, Dello Strologo L, Webb N, Bald M, Genc G, Billing H, König J, Büscher A, Thiel F, Marks S, Pohl M, Wigger M, Topaloglu R, Fichtner A, Rieger S, Krupka K, Tönshoff B. Vaccination Status and Titers Before and After Pediatric Renal Transplantation: An Analysis of the CERTAIN Registry. Am J Transplant. 2016;16 (suppl 3).

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