Live virus vaccination of pediatric solid organ transplant candidates within 1 month prior to transplantation: A multicenter experience

Background Solid organ transplant (SOT) recipients are at increased risk of vaccine‐preventable illness due to the high degree of immunosuppression required following transplantation. The current recommendation is to vaccinate with live attenuated vaccines, including Measles, Mumps, and Rubella (MMR...

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Bibliographic Details
Published in:Transplant infectious disease 2021-08, Vol.23 (4), p.n/a
Main Authors: Rosenthal, Ayelet, Madigan, Theresa, Chen, Sharon F., Gans, Hayley, Nadimpalli, Sruti
Format: Article
Language:English
Subjects:
Attenuation
Heart transplantation
Illnesses
Immunization
Immunosuppression
Literature reviews
live vaccines
Measles
MMR
Mumps
Pediatrics
Priming
Rubella
solid organ transplant
SOT
Transplantation
Transplants & implants
Vaccines
VAR
Varicella
Viremia
Viruses
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Summary:Background Solid organ transplant (SOT) recipients are at increased risk of vaccine‐preventable illness due to the high degree of immunosuppression required following transplantation. The current recommendation is to vaccinate with live attenuated vaccines, including Measles, Mumps, and Rubella (MMR) and Varicella (VAR) vaccines, at least 4 weeks prior to transplant. However, data to support the time interval between vaccine and transplant are limited. Methods We conduct a literature review of the natural history of the viruses and length of viremia following live‐attenuated viral vaccines, and we describe a series of 5 cases from 2 pediatric transplant centers in which live attenuated viral vaccines were administered within 21 days prior to SOT. Results None of the 5 children who received MMR or VAR 8‐21 days prior to liver (2) and heart (3) transplant suffered from vaccine‐related viral illness after transplant, even in the presence of significant immunosuppression with T‐cell‐depleting agents. Conclusion These cases support that shorter intervals of live vaccine administration prior to transplant may be safe, allowing the vaccination of a larger cohort of SOT candidates. Increasing pretransplant vaccinations is crucial since, in most cases, live viral vaccines are contraindicated posttransplantation, and the most effective vaccine approaches utilize prime‐boost strategies, priming before and boosting after transplant.
ISSN:1398-2273
1399-3062
DOI:10.1111/tid.13667