ESPN 50th Annual Meeting

ESPN 2017


 
INCOMPLETE VACCINATION RATES IN EUROPEAN CHILDREN WITH END-STAGE KIDNEY DISEASE PRIOR TO RENAL TRANSPLANTATION – AN ANALYSIS OF THE CERTAIN REGISTRY
BRITTA HÖCKER 1 Martin Aguilar 1 Paul Schnitzler 2 Lars Pape 2 Luca Dello Strologo 2 Nicholas JA Webb 2 Martin Bald 2 Gürkan Genc 2 Heiko M Billing 2 Jens König 2 Anja Büscher 2 Markus J Kemper 2 Stephen D Marks 2 Martin Pohl 2 Marianne Wigger 2 Rezan Topaloglu 2 Alexander Fichtner 1 Susanne Rieger 1 Kai Krupka 1 Burkhard Tönshoff 1

1- UNIVERSITY CHILDREN^S HOSPITAL
2- CERTAIN RESEARCH NETWORK
 
Introduction:

Infections constitute a major cause of morbidity and mortality in paediatric renal allograft recipients on immunosuppressive therapy. Hence, avoidance of preventable systemic infections by vaccination prior to transplantation is of utmost importance. However, data on the completeness of vaccinations and risk factors associated with an incomplete vaccination status in paediatric renal transplant candidates are scarce.

Material and methods:

In the framework of the Cooperative European Paediatric Renal Transplant Initiative (CERTAIN), we therefore launched a multi-centre, multi-national, retrospective study investigating the vaccination status prior to transplantation of 254 European children with end-stage renal disease (mean age 10.0 ± 5.6 years).

Results:

Only 22 of 254 patients (8.7%) presented a complete vaccination status conforming to country- and era-specific immunisation schemes. In particular, the respective vaccination rates against human papillomavirus (27.3%), pneumococci (42.0%) and meningococci (47.9%) were low. Patients with a complete pneumococcal vaccination status had numerically less lower respiratory tract infections during the first three years post-transplant than children without vaccination or with an incomplete status (16.4% vs. 27.7%, p = 0.081). Altogether, vaccine-preventable diseases post-transplant occurred 4.7-fold more frequently in unvaccinated (14/17, 82.4%) than in vaccinated patients (3/17, 17.6%). By multivariate analysis, risk factors associated with an incomplete vaccination status were non-Caucasian ethnicity (OR 9.21, p = 0.004), chronic dialysis treatment before transplantation (OR 6.18, p = 0.001), and older age at transplantation (OR 1.33, p < 0.001) (Table 1).

Table 1

Variable

Unadjusted OR                (95% CI)

p-value

Adjusted OR             (95% CI)

p-value

Older age at RTx

1.25 (1.12 – 1.39)

<0.001

1.33 (1.17 – 1.52)

<0.001

Gender (ref. male)

0.46 (0.16 – 1.28)

0.135

 

 

Ethnicity (ref. Caucasian)

3.74 (1.11 – 12.7)

0.034

9.21 (1.99 – 42.6)

0.004

History of immunosuppressive therapy

1.57 (0.51 – 4.82)

0.431

 

 

Time on waiting list

1.46 (0.88 – 2.42)

0.140

 

 

Dialysis prior to RTx (ref. pre-emptive RTx)

2.80 (1.16 – 6.80)

0.022

6.18 (2.10 – 18.2)

0.001

Donor type (ref. living donor)

1.67 (0.69 – 4.01)

0.254

 

 

OR, odds ratio; CI, confidence interval; RTx, renal transplantation

Conclusions:

The vaccination rates in paediatric kidney transplant candidates are incomplete. Paediatric nephrologists, together with primary-care staff and patients’ families, should therefore take every effort to improve vaccination rates prior to kidney transplantation.