Abstract
Vaccination with the inactivated influenza vaccine is routinely recommended for all patients before and after transplant, with reduction in complications noted in transplant recipients. The vaccine is relatively well tolerated with few mild side effects. Cytomegalovirus (CMV) infection can reactivate in both solid organ transplant and hematopoietic stem cell transplant recipients, with some patients progressing to disease. There are multiple factors known to contribute to reactivation and subsequent CMV disease, however vaccination has not been reported as a specific risk factor.We report on two renal transplant recipients who were seen to develop CMV viremia and CMV disease after receiving the Influenza vaccine. We review the literature regarding viremia occurring after vaccination in HIV patients (a similar group of immunocompromised patients).
Highlights
The inactivated Influenza vaccine is recommended in all solid organ transplant recipients (SOTRs) and it can be administered either before or one month after transplantation [1]
We report on two renal transplant recipients who were seen to develop CMV viremia and CMV disease after receiving the Influenza vaccine
There are multiple risk factors linked to CMV viremia and disease in SOTRs and after hematopoietic stem cell transplant
Summary
The inactivated Influenza vaccine is recommended in all solid organ transplant recipients (SOTRs) and it can be administered either before or one month after transplantation [1]. A 50-year-old female with past medical history of hypertension, autosomal dominant polycystic kidney disease and end-stage renal disease (on hemodialysis) underwent a renal transplant from a living unrelated donor in June 2016 She received the influenza vaccine in November 2017 at the outpatient transplant nephrology clinic. Gastroenterology service was consulted for worsening liver function abnormalities and they attributed the clinical picture to systemic CMV infection She had clinical improvement, with improving CMV PCR tests [504 IU/ml (2.70 log IU/ml)] after 12 days of antiviral therapy. A 62-year-old female with past medical history of endometriosis, hypertension, chronic kidney disease (likely from anti-inflammatory drug use for management of endometriosis) was being followed in the transplant nephrology clinic She received a deceased donor kidney transplant in 1998 that failed in March 2018 and was subsequently on hemodialysis. She was to continue tacrolimus ER 3 mg QD PO and prednisone 5 mg QD PO at home
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