Abstract: PO2345
Vaccination Status in Pediatric Kidney Transplants: An Integrated Pediatric Transplant Research Database Study
Session Information
- Pediatric Nephrology: Glomerular Disease and Transplantation
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
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 Series | Rate (%) | 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