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Live Attenuated Vaccines Well Tolerated After Pediatric Liver Transplant – MPR

October 04, 2013

SAN FRANCISCO—Live attenuated vaccines are well tolerated in pediatric liver transplant recipients, according to results of a prospective study presented at IDWeek 2013.

Administration of live attenuated vaccines is generally contraindicated after liver transplantation thus immunocompromised children receiving immunosuppressants after a liver transplant remain at high risk for severe complications caused by preventable diseases. Specific data on immune response and safety after receiving live vaccines have not been fully elucidated.

Takanori Funaki, MD, from the National Center for Children’s Health and Development, Tokyo, Japan, and colleagues conducted a prospective study evaluating the efficacy of live attenuated vaccines for measles, mumps, rubella, and varicella in 53 children who underwent liver transplant. Patients who received at least one live attenuated vaccine, combination measles and rubella vaccine or individual vaccines for measles, rubella, varicella, and mumps were evaluated between January 2011 and April 2013.

Live vaccines were administered post-transplant when patients met the following criteria:

>2 years after liver transplant

Taking one immunosuppressant or less

Stable liver function and general condition

Seronegative against the disease

≥6 months after a recent episode of acute cellular rejection

Patients’ characteristics, including age, gender, body weight, underlying diseases, date of transplant, past medical history of measles, rubella, varicella, and mumps and vaccination documents were collected from patient medical records. Serum antibody titers for measles (hemagglutinin inhibition [HI] test), rubella (HI), varicella (glycoprotein Enzyme-linked Immunosorbent assay [gpELISA]), and mumps (ELISA) were investigated.

Serological analyses were performed on patients immunized for measles (n=40), rubella (n=40), varicella (n=30), and mumps (n=33) after liver transplant. All patients except one were on low-dose tacrolimus at time of vaccination.

After vaccination, the rate of seropositivity was 77.5% (31/40) for measles, 100% (40/40) for rubella, 66.7% (20/30) for varicella, and 60.6% (20/33) for mumps. The multivariate analyses showed that none of the variables were significantly associated with serological status.

“Humoral responses to live vaccine were effective for rubella, but suboptimal for measles, rubella, and mumps after liver transplant,” Dr. Funaki concluded. Overall, live attenuated vaccines were well tolerated in pediatric liver transplant recipients.

Study researchers concluded, “Further sequential evaluation of humoral response and additional cellular response to live vaccines is needed.”

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