Immunization after kidney transplantation—what is necessary and what is safe?

KEY POINTS * In nephrology and transplant medicine, many opportunities for vaccination and protection against infection are missed * As immunogenicity is generally greater before

transplantation, early in the course of renal disease—or at least before transplantation—is the optimal window of opportunity for vaccination * Delaying vaccination for the first 6–12 months

after transplantation (or repeating vaccines given early) might result in higher rates of protection; nonetheless, influenza vaccine should be given in season * The reported impact of

individual immunosuppressive agents on vaccine responses varies between studies; overall, a lower immunosuppressive protocol is more likely to result in clinical protection * Although some

concern about increased HLA sensitization after vaccination exists, clinical data does not suggest harm; non-live vaccines appear immunogenic, protective and safe * Future research is needed

into the impact of immunosuppressive protocols on vaccination responses, optimal timing after transplantation, dosing regimens, intradermal administration, clinical protection, use of

adjuvants, safety and adverse effects ABSTRACT Many transplant recipients are not protected against vaccine-preventable illnesses, primarily because vaccination is still an underutilized

tool both before and after transplantation. This missed opportunity for protection can result in substantial morbidity, graft loss and mortality. Immunization strategies should be formulated

early in the course of renal disease to maximize the likelihood of vaccine-induced immunity, particularly as booster or secondary antibody responses are less affected by immune compromise

than are primary or de novo antibody responses in naive vaccine recipients. However, live vaccines should be avoided in immunocompromised hosts. Although some concern has been raised

regarding increased HLA sensitization after vaccination, no clinical data to suggest harm currently exists; overall, non-live vaccines seem to be immunogenic, protective and safe. In organ

transplant recipients, some vaccines are indicated based on specific risk factors and certain vaccines, such as hepatitis B, can protect against donor-derived infection. Vaccines given to

close contacts of renal transplant recipients can provide an additional layer of protection against infectious diseases. In this article, optimal vaccination of adult transplant recipients,

including safety, efficacy, indication and timing, is reviewed. Access through your institution Buy or subscribe This is a preview of subscription content, access via your institution ACCESS

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AND 3 DOSE REGIMENS OF HEPATITIS A VACCINE IN KIDNEY TRANSPLANT RECIPIENTS Article Open access 08 January 2021 VACCINATION IN PATIENTS WITH KIDNEY FAILURE: LESSONS FROM COVID-19 Article 23

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AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Infectious Diseases Division, Massachusetts General Hospital, 55 Fruit Street, Cox 5, Boston, 02114, MA, USA Camille N. Kotton Authors * Camille

N. Kotton View author publications You can also search for this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to Camille N. Kotton. ETHICS DECLARATIONS COMPETING

INTERESTS The author declares no competing financial interests. POWERPOINT SLIDES POWERPOINT SLIDE FOR TABLE 1 RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS

ARTICLE Kotton, C. Immunization after kidney transplantation—what is necessary and what is safe?. _Nat Rev Nephrol_ 10, 555–562 (2014). https://doi.org/10.1038/nrneph.2014.122 Download

citation * Published: 29 July 2014 * Issue Date: October 2014 * DOI: https://doi.org/10.1038/nrneph.2014.122 SHARE THIS ARTICLE Anyone you share the following link with will be able to read

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