Abstract
BackgroundInfectious 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.MethodsIn 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.ResultsOf 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.ConclusionVaccine-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.
Highlights
The numbers of solid organ transplant (SOT) recipients have substantially increased in recent decades
Trial Selection We included original research papers published in peerreviewed scientific journals reporting results on adult or paediatric single (controls) or double dose (SOT) recipients that were vaccinated with currently licensed vaccines
This definition included studies where SOT recipients were considered unvaccinated in the pretransplant era, SOT recipients whose vaccination status was not updated before transplantation, SOT recipients with negative antibody status or with unknown vaccination status
Summary
The numbers of solid organ transplant (SOT) recipients have substantially increased in recent decades. Transplant rejection rates decreased with improved immunosuppression and quality of life increased with better post-transplant care. Donor- and recipient- derived, opportunistic, nosocomial or community acquired infections including newly emerging infectious diseases and malignancies remain a problem, [1,2]. Vaccination is the most efficient and cost effective intervention to prevent infectious diseases in healthy persons [5]. The response to vaccines with subsequent protection against infectious diseases, is depending on a functioning immune system. 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
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