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Kidney Week

Abstract: PO2345

Vaccination Status in Pediatric Kidney Transplants: An Integrated Pediatric Transplant Research Database Study

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Parulekar, Jaya S., Wayne State University School of Medicine, Detroit, Michigan, United States
  • Mcgrath, Eric John, Division of Pediatric Infectious Disease, Children's Hospital of Michigan, Detroit, Michigan, United States
  • Jain, Amrish, Division of Pediatric Nephrology, Children’s Hospital of Michigan, Detroit, Michigan, United States
Background

The American Society of Transplant recommends candidates be immunized before transplantation. However, there is limited data on pre/post-transplant vaccination status for children with kidney transplants. Our study evaluates vaccination rates & an approach to increasing vaccination in our kidney transplant program.

Methods

Pediatric kidney transplant recipients at Children’s Hospital of Michigan from 2013-2019 were included. Official immunization records were obtained from the State of Michigan's Michigan Care Improvement Registry. During the pre-transplant period, age-based catch-up or accelerated immunization was performed at primary care provider's or at the in-house immunization center. Demographic, clinical & serology data were entered into an integrated database created through RedCap and analyzed with SPSS Version 26.

Results

Included were 58 children with mean age at transplant of 11.9±5.7 yrs, 66% Male, 52% African-American, 31% Caucasian, 76% deceased donor transplants & 10% re-transplants. Median duration of follow-up was 3 yrs. Pre-transplant vaccination rates of ≥95% were achieved for all vaccines, except PCV13 (69%), PCV23 (62%) & HPV4/9 (86%). Pre-transplant serology for HepA, HepB and Varicella showed immunogenicity of 95%, 93%, 88% respectively. Catch-up & accelerated immunization increased the vaccination rate to 100% from 53% (Varicella); 57% (HepA); 73% (MCV); 72% (MMR). Post transplant vaccination series was ≥ 95% complete for all vaccines except PCV23 (43%); HPV4/9 (37%); MCV (30%).

Conclusion

A systematic approach using catch-up & accelerated immunization improves vaccination rates. Regular monitoring of immunization record post-transplant is required to maintain up-to-date status.

Pre & Post-transplant vaccination data (n=58)
Vaccination SeriesRate (%)Dose # (range)Routine vs. Catch-Up vs. Accelerated Vaccination (%)Series Incomplete (%)
DTaP/Tdap Pre-transplant
DTaP/Tdap Post-transplant
100
21
3-7
0-1
96.6
20.7
3.4
0
0
0
3.3
3.4
HiB Pre-transplant
HiB Post-transplant
95
0
1-5
0
91.4
0
3.4
0
0
0
25.9
0
Polio Pre-transplant
Polio Post-transplant
100
9
2-3
0
96.6
8.5
3.4
0
0
0
6.9
1.7
MMR Pre-transplant
MMR Post-transplant
100
0
2-3
0
72.4
0
12.1
0
15.5
0
0
0
Varicella Pre-transplant
Varicella Post-transplant
100
0
1-3
0-1
53.4
0
31.0
0
15.5
0
0
0
Hep A Pre-transplant
Hep A Post-transplant
100
2
1-3
0-1
56.9
0
41.4
1.7
1.7
0
3.4
3.4
Hep B Pre-transplant
Hep B Post-transplant
97
0
3-7
0
86.2
0
31.0
0
0
0
3.4
3.4
PCV7/13 Pre-transplant
PCV7/13 Post-transplant
69
0
1-6
0
62.1
0
6.9
0
0
0
17.2
0
PCV23 Pre-transplant
PCV23 Post-transplant
62
2
1-3
1
27.6
1.7
34.5
0
0
0
37.9
56.9
MCV Pre-transplant (n = 37)
MCV Post-transplant (n = 30)
100
33
1-4
1-2
73.0
30.0
27.0
3.3
0
0
10.8
70.0
HPV 4/9 Pre-transplant (n = 37)
HPV 4/9 Post-transplant (n = 30)
86
32
1-3
1-2
62.2
20.0
24.3
12.0
0
0
27.0
63.3
Influenza Pre-transplant
Influenza Post-transplant
98
97
1-6
1-6
98.3
96.6
0
0
0
0
3.5
24.1

Funding

  • Private Foundation Support