Seasonal maintenance of influenza vaccine-induced antibody response in kidney transplant recipients

Abstract

Background/aims: Although annual influenza vaccination is recommended for kidney transplant recipients, efficacy as reflected by serum antibody titers has not been well studied beyond 1 month in kidney transplant recipients.

Methods: We performed a single-center prospective cohort study of 51 kidney transplant recipients and 102 healthy controls receiving the 2006-2007 influenza vaccine. Anti-hemagglutinin antibody titers to A/H1N1, A/H3N2, and B were measured before and 1 month after vaccination, and again at the end of influenza season. The primary outcome was the proportion of participants maintaining seroprotection (antibody titer ≥1:32) for the duration of the influenza season after influenza vaccination.

Results: Median follow-up time was 175 and 155 days in the transplant and control groups, respectively. For types A/H1N1 and B, a similar high proportion of the transplant and control groups (88.5 and 81.6% vs. 83.7 and 74.2% for A/H1N1 and B, respectively) maintained seroprotection. For type A/H3N2, significantly less of the transplant group (66.7%) versus the control group (90%) maintained a protective influenza vaccine response (odds ratio 0.21, 95% confidence interval 0.07-0.64). This difference disappeared in adjusted analyses. Actual geometric mean titers decreased significantly within both groups (p < 0.001) but this did not differ between groups.

Conclusions: Once they have developed protective vaccine-induced antibody responses to influenza vaccine, kidney transplant recipients are able to maintain adequate protective levels of antibody compared with healthy controls.

Figure 1

Study enrollment and follow up.

Figure 2

Serologic response to the 2006–07 inactivated influenza vaccine expressed as geometric mean titers for the 123 participants. For control group: A/H1N1 pre 35.8, post 113.7, end 60.1; A/H3N2 pre 41, post 210.9, end 78.1; B pre 41.5, post 150.4, end 69.7. For transplant group: A/H1N1 pre 39.2, post 68.1, end 44; A/H3N2 pre 22, post 49.2, end 26.8; B pre 39.2, post 87.5, end 45.7.