534. Efficacy and Safety of Live Attenuated Vaccines Administered after Liver Transplantation in Children
Session: Poster Abstract Session: Vaccine Use in Immunocompromised Hosts
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
  • Funaki et al. IDweek2013 final.pdf (330.2 kB)
  • Background: Live attenuated vaccines are generally contraindicated after liver transplantation (LT) although immunocompromised children receiving immunosuppressants after LT remain at high risk for severe complications of the diseases which each vaccine can prevent. The vaccines have been given to children after LT; however, detailed immune responses after receiving vaccine and safety of vaccines have not elucidated.

    Methods: We conducted a prospective study to evaluate the efficacy and safety of live attenuated vaccines for children who underwent LT in 2010. Patients’ demographics, underlying diseases, and vaccination records were reviewed. Vaccines were administered after LT when they met the following conditions: 1) ≥2years after LT, 2) on one immunosuppressant or less, 3) stable liver function and general condition, 4) seronegative to the diseases. Serum antibody titers for measles (hemagglutinin inhibition (HI) test), rubella (HI), varicella (enzyme-linked immunosorbent assay (ELISA)), and mumps (ELISA) were investigated. Any adverse events after the vaccines were collected from the medical records.

    Results: Serological analyses were performed on 30, 30, 23, and 28 patients immunized for measles, rubella, varicella, and mumps after LT, respectively (median age: 49, 49, 49, and 53 months). Underlying diseases were biliary atresia (53%, 57%, 61%, and 59%, respectively), metabolic disorders (23%, 23%, 17%, and 11%), fulminant hepatic failure (13%, 13%, 4%, and 15%), and others (10%, 7%, 17%, and 19%). All patients except one patient were on low dose tacrolimus (trough: 1.7, 1.8, 1.8, and 1.7 [median, μg/ml]) at the time of vaccine administration. The rate of seropositivity after measles, rubella, varicella, and mumps vaccination were 73.3% (22/30), 100% (30/30), 69.6% (16/23), and 60.7% (17/28), respectively. None of the variables examined were significantly associated with serological status after multivariate analyses. No definite serious adverse reactions after immunization were observed.

    Conclusion: Humoral responses to live vaccine were effective for rubella, but suboptimal for measles, rubella, and mumps after LT. Live attenuated vaccines were well tolerated in pediatric LT recipients under our protocol. Further sequential evaluation of humoral response and additional cellular response to live vaccines is needed.

    Takanori Funaki, MD1, Kensuke Shoji, MD1, Hironori Yoshii2, Seisuke Sakamoto, MD, PhD1, Mureo Kasahara, MD1, Isao Miyairi, MD3 and Akihiko Saitoh, MD, PhD1, (1)National Center for Child Health and Development, Tokyo, Japan, (2)Research Foundation for Microbial Diseases of Osaka University, Kagawa, Japan, (3)St Jude Children's Research Hospital, Memphis, TN


    T. Funaki, None

    K. Shoji, None

    H. Yoshii, None

    S. Sakamoto, None

    M. Kasahara, None

    I. Miyairi, None

    A. Saitoh, None

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