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Immunization after kidney transplantation—what is necessary and what is safe?

Nature Reviews Nephrology volume 10, pages 555–562 (2014)Cite this article

Subjects

Key Points

  • In nephrology and transplant medicine, many opportunities for vaccination and protection against infection are missed

  • As immunogenicity is generally greater before transplantation, early in the course of renal disease—or at least before transplantation—is the optimal window of opportunity for vaccination

  • Delaying vaccination for the first 6–12 months after transplantation (or repeating vaccines given early) might result in higher rates of protection; nonetheless, influenza vaccine should be given in season

  • The reported impact of individual immunosuppressive agents on vaccine responses varies between studies; overall, a lower immunosuppressive protocol is more likely to result in clinical protection

  • Although some concern about increased HLA sensitization after vaccination exists, clinical data does not suggest harm; non-live vaccines appear immunogenic, protective and safe

  • Future research is needed into the impact of immunosuppressive protocols on vaccination responses, optimal timing after transplantation, dosing regimens, intradermal administration, clinical protection, use of adjuvants, safety and adverse effects

Abstract

Many transplant recipients are not protected against vaccine-preventable illnesses, primarily because vaccination is still an underutilized tool both before and after transplantation. This missed opportunity for protection can result in substantial morbidity, graft loss and mortality. Immunization strategies should be formulated early in the course of renal disease to maximize the likelihood of vaccine-induced immunity, particularly as booster or secondary antibody responses are less affected by immune compromise than are primary or de novo antibody responses in naive vaccine recipients. However, live vaccines should be avoided in immunocompromised hosts. Although some concern has been raised regarding increased HLA sensitization after vaccination, no clinical data to suggest harm currently exists; overall, non-live vaccines seem to be immunogenic, protective and safe. In organ transplant recipients, some vaccines are indicated based on specific risk factors and certain vaccines, such as hepatitis B, can protect against donor-derived infection. Vaccines given to close contacts of renal transplant recipients can provide an additional layer of protection against infectious diseases. In this article, optimal vaccination of adult transplant recipients, including safety, efficacy, indication and timing, is reviewed.

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Authors and Affiliations

  1. Infectious Diseases Division, Massachusetts General Hospital, 55 Fruit Street, Cox 5, Boston, 02114, MA, USA

    Camille N. Kotton

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  1. Camille N. Kotton
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Correspondence to Camille N. Kotton.

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The author declares no competing financial interests.

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Kotton, C. Immunization after kidney transplantation—what is necessary and what is safe?. Nat Rev Nephrol 10, 555–562 (2014). https://doi.org/10.1038/nrneph.2014.122

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