Original Investigation
Transplantation
Decreased Antibody Response to Influenza Vaccination in Kidney Transplant Recipients: A Prospective Cohort Study

https://doi.org/10.1053/j.ajkd.2008.09.023Get rights and content

Background

Antibody response to the inactivated influenza vaccine is not well described in kidney transplant recipients administered newer, but commonly used, immunosuppression medications. We hypothesized that kidney transplant recipient participants administered tacrolimus-based regimens would have decreased antibody response compared with healthy controls.

Study Design

Prospective cohort study of 53 kidney transplant recipients and 106 healthy control participants during the 2006-2007 influenza season. All participants received standard inactivated influenza vaccine.

Setting & Participants

Kidney transplant recipients administered tacrolimus-based regimens at a single academic medical center and healthy controls.

Predictor

Presence of kidney transplant.

Outcomes

Proportion of participants achieving seroresponse (4-fold increase in antibody titer) and seroprotection (antibody titer ≥ 1:32) 1 month after vaccination.

Measurements

Antibody titers before and 1 month after vaccination by means of hemagglutinin inhibition assays for influenza types A/H1N1, A/H3N2, and B.

Results

A smaller proportion of the transplantation group compared with the healthy control group developed the primary outcomes of seroresponse or seroprotection for all 3 influenza types at 1 month after vaccination. The response to influenza type A/H3N2 was statistically different; the transplantation group had 69% decreased odds of developing seroresponse (95% confidence interval, 0.16 to 0.62; P = 0.001) and 78% decreased odds of developing seroprotection (95% confidence interval, 0.09 to 0.53; P = 0.001) compared with healthy controls. When participants less than 6 months from the time of transplantation were considered, this group had a significantly decreased response to the vaccine compared with healthy controls.

Limitations

Decreased sample size, potential for confounders, outcome measure used is the standard but does not give information about vaccine efficacy.

Conclusions

Kidney transplant recipients, especially within 6 months of transplantation, had diminished antibody response to the 2006-2007 inactivated influenza vaccine.

Section snippets

Study Design

The Institutional Review Board of Vanderbilt University Medical Center (VUMC; Nashville, TN) approved this project, and informed consent was obtained from all study participants. We conducted a prospective cohort study of kidney transplant recipients and healthy controls at VUMC to compare antibody response to the trivalent inactivated intramuscularly administered influenza vaccine in kidney transplant recipients administered a tacrolimus-based immunosuppression regimen with that of healthy

Baseline Characteristics

A total of 107 healthy control individuals and 59 kidney transplant recipients were enrolled in the study during October and November 2006; of these, 106 control and 53 transplant recipient participants completed the second follow-up visit (99% and 90%, respectively; Fig 1). No difference in the ages of the 2 groups was seen (control mean age, 41.0 ± 12 years; transplant recipient mean age, 44.0 ± 10.3 years). Other demographics varied, with more women in the healthy control group and more

Discussion

In this prospective cohort study, we show that the proportion of participants developing a 4-fold increase in titer or a postvaccination titer greater than 1:32 to the 2006-2007 inactivated influenza vaccine was decreased in kidney transplant recipients compared with healthy controls. Although the overall difference was statistically significant for only the A/H3N2 type, participants less than 6 months posttransplantation had significantly decreased antibody responses for all 3 influenza types

Acknowledgements

The authors would like to thank the physicians staff, and patients of the Vanderbilt Medical Center Kidney/Pancreas Transplant Center for their participation and assistance in this study.

Support: Supported in part by Vanderbilt CTSA Grant 1 UL1 RR024975 from the National Center for Research Resources, National Institutes of Health (NIH); NIH/NRSA Training Grant 5 T32 DK007569-17; and K24 DK62849 from the National Institute of Diabetes, Digestive and Kidney Diseases.

Financial Disclosure: None.

References (33)

  • R.C. Pabico et al.

    Antibody response to influenza vaccination in renal transplant patients: Correlation with allograft function

    Ann Intern Med

    (1976)
  • H.G. Stiver et al.

    Impaired serum antibody response to inactivated influenza A and B vaccine in renal transplant recipients

    Infect Immun

    (1977)
  • S.S. Kumar et al.

    Influenza vaccination in renal transplant recipients

    JAMA

    (1978)
  • W.A. Briggs et al.

    Influenza vaccination in kidney transplant recipients: Cellular and humoral immune responses

    Ann Intern Med

    (1980)
  • K.L. Huang et al.

    Antibody response after influenza immunization in renal transplant patients receiving cyclosporin A or azathioprine

    Infect Immun

    (1983)
  • D.J. Versluis et al.

    Impairment of the immune response to influenza vaccination in renal transplant recipients by cyclosporine, but not azathioprine

    Transplantation

    (1986)
  • Cited by (0)

    Originally published online as doi: 10.1053/j.ajkd.2008.09.023 on January 30, 2009.

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