Background: Vaccinations are often the first line of defense in preventing illness. These routine childhood vaccinations are especially important and potentially lifesaving in pediatric transplant recipients. The requirements for lifelong immunosuppression, which increases susceptibility to infection and may attenuate response to future immunizations, make optimization of pre-transplant immunization critically important.

Method: 41 patients who were referred for evaluation for liver transplantation at Georgetown University Hospital between January 2008 and December 2011 were included in this study. Vaccination status at the time of initial evaluation and at the time of transplant was reviewed according to the CDC recommended immunization schedule for age. For patients who were not up to date at the time of transplant, it was determined as to whether an accelerated immunization schedule initiated at the time of initial evaluation could have brought these patients up to date.

Results: At the time of initial evaluation, thirty-two percent of patients were fully vaccinated for age, 71% for DTaP, 74% for IPV, 68% for HIB, 42% for Hepatitis A, 89% for Hepatitis B, 75% for MMR, 58% for VZV, 11% for MCV, 39% for PCV, and 50% for Rotavirus. At the time of liver transplantation, thirty-seven percent of patients were fully vaccinated for age, 70% for DTaP, 80% for IPV, 69% for HIB, 53% for Hepatitis A, 87% for Hepatitis B, 84% for MMR, 67% for VZV, 18% for MCV, 45% for PCV, and 46% for Rotavirus. Of patients who were not up to date at transplant, 53% of those patients could have been brought up to date between the time of initial evaluation and transplantation using an accelerated vaccine schedule.

Conclusions: A significant proportion of patients were not up to date on immunizations upon presentation for liver transplantation evaluation and the numbers remained poor at the time of transplantation. A concerted effort to accelerate and ensure vaccination in the interim between evaluation and transplantation should be effective in raising immunization rates in this population. However, many patients undergo transplant too emergently for interim vaccination to be feasible, underscoring the importance of improving baseline vaccination compliance.

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