Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013;8(2):e56974.
doi: 10.1371/journal.pone.0056974. Epub 2013 Feb 22.

Serologic vaccination response after solid organ transplantation: a systematic review

Isabella Eckerle  1 , Kerstin Daniela Rosenberger, Marcel Zwahlen, Thomas Junghanss
Affiliations

Serologic vaccination response after solid organ transplantation: a systematic review

Isabella Eckerle et al. PLoS One. 2013.

Abstract

Background: Infectious diseases after solid organ transplantation (SOT) are one of the major complications in transplantation medicine. Vaccination-based prevention is desirable, but data on the response to active vaccination after SOT are conflicting.

Methods: In this systematic review, we identify the serologic response rate of SOT recipients to post-transplantation vaccination against tetanus, diphtheria, polio, hepatitis A and B, influenza, Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitides, tick-borne encephalitis, rabies, varicella, mumps, measles, and rubella.

Results: Of the 2478 papers initially identified, 72 were included in the final review. The most important findings are that (1) most clinical trials conducted and published over more than 30 years have all been small and highly heterogeneous regarding trial design, patient cohorts selected, patient inclusion criteria, dosing and vaccination schemes, follow up periods and outcomes assessed, (2) the individual vaccines investigated have been studied predominately only in one group of SOT recipients, i.e. tetanus, diphtheria and polio in RTX recipients, hepatitis A exclusively in adult LTX recipients and mumps, measles and rubella in paediatric LTX recipients, (3) SOT recipients mount an immune response which is for most vaccines lower than in healthy controls. The degree to which this response is impaired varies with the type of vaccine, age and organ transplanted and (4) for some vaccines antibodies decline rapidly.

Conclusion: Vaccine-based prevention of infectious diseases is far from satisfactory in SOT recipients. Despite the large number of vaccination studies preformed over the past decades, knowledge on vaccination response is still limited. Even though the protection, which can be achieved in SOT recipients through vaccination, appears encouraging on the basis of available data, current vaccination guidelines and recommendations for post-SOT recipients remain poorly supported by evidence. There is an urgent need to conduct appropriately powered vaccination trials in well-defined SOT recipient cohorts.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flowchart of study selection.
Figure 2
Figure 2. Forest plot for short-term response for vaccines from category A (tetanus, diphtheria, polio), B (hepatitis A and B), D (Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitides), E (varicella, mumps, measles, rubella) and F (tick-borne encephalitis and rabies).
All article types are included. Numbers in brackets refer to legend in Table 3.
Figure 3
Figure 3. Forest plot for short-term response for vaccine category C (influenza) against influenza H1N1.
All type of trials which assessed specific response to H1N1 are included. Numbers in brackets refer to legend in Table 3.
Figure 4
Figure 4. Forest plot for short-term response for vaccine category C (influenza) against influenza H3N2.
All type of trials which assessed specific response to H3N2 are included. Numbers in brackets refer to legend in Table 3.
Figure 5
Figure 5. Forest plot for short-term response for vaccine category C (influenza) against influenza B.
All type of trials which assessed specific response to B are included. Numbers in brackets refer to legend in Table 3.
Figure 6
Figure 6. Meta-analysis for case-control studies using the Mantel-Haenszel fixed effects method (M–H) and the DerSimonian and Laird random effects (D+L) method for response to influenza H1N1.
Numbers in brackets refer to legend in Table 3.
Figure 7
Figure 7. Meta-analysis for case-control studies using the Mantel-Haenszel fixed effects method (M–H) and the DerSimonian and Laird random effects (D+L) method for response to influenza H3N2.
Numbers in brackets refer to legend in Table 3.
Figure 8
Figure 8. Meta-analysis for case-control studies using the Mantel-Haenszel fixed effects method (M–H) and the DerSimonian and Laird random effects (D+L) method for response to influenza B.
Numbers in brackets refer to legend in Table 3.
Figure 9
Figure 9. Forest plot for studies investigating both short-term response (grey bars and numbers) and long-term response (black bars and numbers).
See this image and copyright information in PMC

References

    1. Grossi PA, Costa AN, Fehily D, Blumberg EA, Kuehnert MJ, et al. (2012) Infections and organ transplantation: new challenges for prevention and treatment–a colloquium. Transplantation 93: S4–S39. - PubMed
    1. Fishman JA (2011) Infections in immunocompromised hosts and organ transplant recipients: essentials. Liver Transpl 17 Suppl 3S34–37. - PubMed
    1. Kelesidis T, Daikos G, Boumpas D, Tsiodras S (2011) Does rituximab increase the incidence of infectious complications? A narrative review. Int J Infect Dis 15: e2–16. - PMC - PubMed
    1. Gentile G, Foa R (2011) Viral infections associated with the clinical use of monoclonal antibodies. Clin Microbiol Infect 17: 1769–1775. - PubMed
    1. Plotkin SL, Plotkin SA (2008) A short history of vaccination. In: Plotkin SA, Orenstein WA, Offit PA, editors. Vaccines. Saunders Elsevier. 1–16.

Publication types