ESPN 50th Annual Meeting

ESPN 2017


 
HIGH RATE OF SECONDARY VACCINATION TITRE LOSSES IN PAEDIATRIC RENAL TRANSPLANT RECIPIENTS: 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 Susanne Rieger 1 Alexander Fichtner 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 vaccine-preventable systemic infections is of utmost importance. However, the development and maintenance of protective vaccination titres may be impaired in this patient population due to their need of immunosuppressive medication.

Material and methods:

In the framework of the Cooperative European Paediatric Renal Transplant Initiative (CERTAIN), we therefore performed a multicentre, cross-sectional study in 254 patients and analysed the post-transplant course of vaccination titres in a subset of 150 patients for whom serial titre measurements were available.

Results:

The rate of protective vaccination titres in uraemic children prior to transplantation was low, especially for diphtheria (38.5%) and pertussis (21.3%). As few as 58.1% of patients developed a hepatitis B titre (HBsAb titre) > 100 I.U./L prior to RTx. 39.6% of patients showed a secondary vaccination titre loss post-transplant, especially against the life-virus vaccines varicella and mumps as well as the inactivated vaccines tetanus, diphtheria, pneumococcus and hepatitis B (Fig. 1). Patients with a HBsAb titre between 10 and 100 I.U./L prior to RTx (baseline) experienced significantly (p < 0.05) more often a hepatitis B vaccination titre loss post-transplant than patients with a baseline HBsAb titre > 100 I.U./L (Fig. 2). The revaccination rate post-transplant was low and failed to induce protective titres in a considerable amount of patients: only 37.5% developed a sufficient HBsAb titre, and as few as 14.3% of patients showed a protective pertussis titre after revaccination. Treatment with rituximab was associated with a significantly increased risk of a vaccination titre loss post-transplant (odds ratio 3.9; p = 0.044).

 

Conclusions:

We observed a high rate of secondary vaccination titre losses post-transplant also for the inactivated vaccines tetanus, diphtheria, pneumococcus and hepatitis B. We therefore recommend in accordance with the AST guidelines to measure vaccination titres including tetanus, hepatitis B and pneumococcus at regular intervals post-transplant in order to induce timely revaccination and thus to avoid the development of vaccine-preventable diseases.