Britta Höcker1, Martin Aguilar1, Paul Schnitzler2, Lars Pape3, Martin Bald4, Jens König5, Stephen D Marks6, Gurkan Genc7, Anja Büscher8, Markus J Kemper9, Heiko Billing10, Martin Pohl11, Luca Dello Strologo12, Nicholas J A Webb13, Susanne Rieger1, Annette Mankertz14, Kai Krupka1, Thomas Bruckner15, Alexander Fichtner1, Burkhard Tönshoff16. 1. Department of Paediatrics I, University Children's Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany. 2. Department of Infectious Diseases, Virology, University Hospital Heidelberg, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany. 3. Hanover Medical School, Carl-Neuberg-Strasse 1, 30625, Hanover, Germany. 4. Olga Children's Hospital, Clinic of Stuttgart, Kriegsbergstrasse 62, 70174, Stuttgart, Germany. 5. Department of General Paediatrics, Paediatric Nephrology, University Children's Hospital, Waldeyerstrasse 22, 48149, Münster, Germany. 6. Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK. 7. Children's Hospital, Paediatric Nephrology Department, Ondokuz Mayis University Faculty of Medicine, Kurupelit, 55139, Samsun, Turkey. 8. University Children's Hospital, Hufelandstrasse 55, 45122, Essen, Germany. 9. University Children's Hospital, Martinistrasse 52, 20246, Hamburg, Germany. 10. University Children's Hospital, Hoppe-Seyler-Strasse 1, 72076, Tübingen, Germany. 11. Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Mathildenstrasse 1, 79106, Freiburg, Germany. 12. IRCCS Ospedale Pediatrico Bambino Gesù, Piazza di Sant'Onofrio 4, 00165, Rome, Italy. 13. Royal Manchester Children's Hospital, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, M13 9WL, Manchester, UK. 14. National Reference Centre Measles, Mumps, Rubella, Robert Koch-Institute, Seestrasse 10, 13353, Berlin, Germany. 15. Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany. 16. Department of Paediatrics I, University Children's Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany. burkhard.toenshoff@med.uni-heidelberg.de.
Abstract
BACKGROUND: Avoidance of vaccine-preventable infections in paediatric renal allograft recipients is of utmost importance. However, the development and maintenance of protective vaccination titres may be impaired in this patient population owing to their need for immunosuppressive medication. METHODS: In the framework of the Cooperative European Paediatric Renal Transplant Initiative (CERTAIN), we therefore performed a multi-centre, multi-national study and analysed vaccination titres pre- and post-transplant in 155 patients with serial titre measurements in comparison with published data in healthy children. RESULTS: The percentage of patients with positive vaccination titres before renal transplantation (RTx) was low, especially for diphtheria (38.5%, control 75%) and pertussis (21.3%, control 96.3%). As few as 58.1% of patients had a hepatitis B antibody (HBsAb) titre >100 IU/L before RTx. 38.1% of patients showed a vaccination titre loss post-transplant. Patients with an HBsAb titre between 10 and 100 IU/L before RTx experienced a significantly (p < 0.05) more frequent hepatitis B vaccination titre loss post-transplant than patients with an HBsAb titre >100 IU/L. The revaccination rate post-transplant was low and revaccination failed to induce positive titres in a considerable number of patients (27.3 to 83.3%). Treatment with rituximab was associated with a significantly increased risk of a vaccination titre loss post-transplant (odds ratio 4.26, p = 0.033). CONCLUSIONS: These data show a low percentage of patients with positive vaccination titres pre-transplant, a low revaccination rate post-transplant with limited antibody response, and a high rate of vaccination titre losses.
BACKGROUND: Avoidance of vaccine-preventable infections in paediatric renal allograft recipients is of utmost importance. However, the development and maintenance of protective vaccination titres may be impaired in this patient population owing to their need for immunosuppressive medication. METHODS: In the framework of the Cooperative European Paediatric Renal Transplant Initiative (CERTAIN), we therefore performed a multi-centre, multi-national study and analysed vaccination titres pre- and post-transplant in 155 patients with serial titre measurements in comparison with published data in healthy children. RESULTS: The percentage of patients with positive vaccination titres before renal transplantation (RTx) was low, especially for diphtheria (38.5%, control 75%) and pertussis (21.3%, control 96.3%). As few as 58.1% of patients had a hepatitis B antibody (HBsAb) titre >100 IU/L before RTx. 38.1% of patients showed a vaccination titre loss post-transplant. Patients with an HBsAb titre between 10 and 100 IU/L before RTx experienced a significantly (p < 0.05) more frequent hepatitis B vaccination titre loss post-transplant than patients with an HBsAb titre >100 IU/L. The revaccination rate post-transplant was low and revaccination failed to induce positive titres in a considerable number of patients (27.3 to 83.3%). Treatment with rituximab was associated with a significantly increased risk of a vaccination titre loss post-transplant (odds ratio 4.26, p = 0.033). CONCLUSIONS: These data show a low percentage of patients with positive vaccination titres pre-transplant, a low revaccination rate post-transplant with limited antibody response, and a high rate of vaccination titre losses.
Entities:
Keywords:
Hepatitis B; Paediatric; Renal transplantation; Rituximab; Vaccination; Vaccination titre
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