Ageing of Immune System and Response to a Live-Attenuated Herpes Zoster Vaccine in Lung Transplant Candidates.

Lei Wang,Davy Paap,Erik A.M Verschuuren,Johanna Westra,Siqi Liu,Christien Rondaan,Nicolaas A Bos,Elisabeth Raveling-Eelsing

doi:10.3390/vaccines9030202

Lei Wang, Davy Paap + Show 6 more

Open Access

https://doi.org/10.3390/vaccines9030202

Copy DOI

Abstract

The mean age of lung transplant recipients has significantly increased in recent decades. Elderly recipients have a higher risk of developing herpes zoster (HZ), and they have in general a worse response to vaccination than younger persons do. We investigated the relationship between the humoral and cellular immune response to a live-attenuated HZ vaccine (Zostavax®, Merck Sharp and Dohme) and the frequencies of T and B cell subsets, especially aged cell subsets (CD28−T cells and age associated B cells, ABCs). In total, 37 patients awaiting lung transplantation received one dose of Zostavax®, and peripheral blood was collected before and within 6 months after vaccination. We observed a robust immune response after vaccination. The frequencies of CD28−T cells before vaccination had no impact on the subsequent immune response to HZ vaccination. However, a higher frequency of ABCs before vaccination correlated with a lower immune response especially regarding the cellular immune response. Cytomegalovirus seropositivity was associated with increased frequencies of CD28−T cells but not with frequencies of ABCs in the patients. In conclusion, increased levels of ABCs might disturb the cellular immune response to HZ vaccination, which could lower the efficacy of such vaccination in elderly transplant recipients.

Highlights

Lung transplantation is a final treatment for end-stage pulmonary disease (ESPD), providing an improved quality of life and survival benefit for the patients
Elderly recipients had a lower incidence of acute rejection, but they did have higher infection rate than younger recipients, and both could be caused by the declined immune system function with ageing, termed immunosnescence [5]
At the University Medical Center Groningen (UMCG), all varicella zoster virus (VZV) seropositive ESPD patients who were newly screened for lung transplantation were given 1 dose of Zostavax® (Merck Sharp and Dohme, Kenilworth, USA)

Summary

Introduction

Lung transplantation is a final treatment for end-stage pulmonary disease (ESPD), providing an improved quality of life and survival benefit for the patients. With the ageing of the population, the age of lung transplant recipients is increasing. From 2006 to mid-2012, 10% of the lung transplant recipients were older than 65 years, approximately 3 times higher than in the years from 2000 to 2005 [3]. Despite the fact that age has no longer been considered an absolute restriction for transplantation, elderly recipients do have a lower survival rate after lung transplantation than younger recipients [4]. Elderly recipients had a lower incidence of acute rejection, but they did have higher infection rate than younger recipients, and both could be caused by the declined immune system function with ageing, termed immunosnescence [5]

Objectives

Methods

Results

Discussion

Conclusion