Influenza virus vaccination and kidney graft rejection: causality or coincidence

Abstract

Influenza can cause significant morbidity and mortality in renal transplant recipients especially with a high rate of lower respiratory disease. Annual influenza vaccination is therefore recommended to renal transplant recipients. We report the first three cases of acute kidney injury in renal transplant recipients following influenza vaccination that all led to graft loss. They all had different native diseases and were all vaccinated in the same season of 2009-10. The time span from vaccination to decline of kidney function is shorter than the time to diagnosis since the three patients only had blood tests every 3 months or when symptoms became severe. These reports do not justify a change of current recommendations regarding influenza vaccination in renal transplant recipients, but they support the continued attention and registration of vaccinations to monitor side effects.

Keywords: acute kidney injury; influenza vaccination; kidney graft rejection; renal transplant recipient.

Fig. 1.

Kidney biopsy of Case 2.

Fig. 2.

The three figures show estimated glomerular filtration rate (e-GFR) for the cases over time. The graphs end when dialysis was initiated. The arrow indicates the time of vaccination. e-GFR is estimated using the MDRD study equation [16].