Background: Adherence rates for recommended pre-transplant (pre-txp) vaccinations in pediatric solid organ transplant (SOT) patients are variable and practice-dependent. Cleveland Clinic Childrens Hospital (CCCH) pre-txp adherence rates for select vaccines have not been described. The purpose of this study was to evaluate pre-txp adherence rates for the following vaccines: hepatitis B, influenza, pneumococcal conjugate (PCV13), pneumococcal polysaccharide (PPSV23), and hepatitis A (if at-risk).
Methods: This retrospective cohort study included patients undergoing initial pediatric heart, kidney, liver, or intestine/multi-visceral transplant at CCCH between 1/1/14 and 7/31/17. Data collected from the electronic medical record and Ohio Department of Health Statewide Immunization Information System included demographics, transplant-related data, immunization administration history, and quantitative/qualitative values for titer/serology. The primary objective of vaccination adherence rate was defined as the aggregate of patients who had completed the vaccine series, had positive titer/serology data, or were ineligible to receive the vaccine due to age or administration restrictions. Data are descriptive in nature and reported as number (percent) or median (interquartile range), as appropriate.
Results: 64 pediatric SOT recipients met inclusion criteria. Median age was 7.9 (2.1, 15.8) years. Majority of patients were American (73%) and male (63%). Most common organ was heart (41%), followed by liver (25%), kidney (21%), and intestine/multi-visceral (13%). Sixty-three (98%) patients underwent ID pre-txp evaluation. CCCH adherence rates were highest for hepatitis B at 92%, followed by PCV13 and PPSV23 at 84%, and influenza at 72%. Thirty-two (50%) patients were indicated to receive the hepatitis A vaccine and the respective adherence rate was 91%. Vaccination adherence by SOT team is described in Figure 1.
Conclusion: CCCH pre-txp vaccination adherence rates are higher than previously reported. Opportunities for improvement include influenza vaccination adherence across all SOT teams and PCV13/PPSV23 vaccination adherence in intestine/multi-visceral transplant patients.
Figure 1: CCCH SOT Team Vaccination Adherence Rates
A. Pallotta, None
M. Spinner, None
M. Lepak, None
B. E. Gonzalez, None