Table 2.
Efficacy and safety of vaccines in transplant recipients (examples).
| Vaccine | Type of study/population | Response in transplant recipients | Ref. |
|---|---|---|---|
| Seasonal influenza vaccine | Systematic review of 36 studies SOT patients |
High variability of the response. Overall a 10% to 16% lower response rate in SOT recipients vs. controls. Calcineurin-inhibitors and azathioprine were associated with a slightly better response compared to sirolimus and MMF. | 32 |
| Meta-analysis with 8 studies (SOT patients): | Transplant recipients receiving MMF had a significantly lower response rate. | 33 | |
| Systematic review of 7 studies (SOT patients) | Heterogenous responses. Despite alternative influenza vaccination strategies, seroconversion and seroprotection rates for influenza antigens were lower in SOT patients. | 34 | |
| Systematic review of 9 studies | A booster dose of the influenza vaccine did not effectively enhance immunogenicity in renal transplant recipients. | 35 | |
| Systematic review and meta-analysis | 15 studies reported influenza-like illness with comparable rates between vaccinated transplant patients and immunocompetent controls. 55 studies reported on the serologic response to influenza vaccination. A weaker response to influenza vaccination was observed compared with immunocompetent controls, although some studies showed a comparable or increased response for some influenza subtypes. 25 studies described adverse events at rates comparable to healthy or placebo-vaccinated controls. 30 studies investigated rejection reactions or allograft function in transplant recipients vaccinated against influenza; however, no consistent evidence of an association with these outcomes or serious adverse events was found. |
36 | |
| Mumps, measles, and rubella vaccine | Systematic review of 4 studies (SOT patients): | Heterogenous responses. Overall, the observed positive response rates were above 70% in all but 1 study. | 32 |
| Adjuvanted subunit varicella zoster vaccine | Systematic review of 6 studies (immunocompromised adults aged 18-49 years): | Significant humoral and cellular immune responses even in patients with the highest level of immunosuppression (sustained for at least 24 weeks); no safety concern, no evidence of graft rejection compared to placebo groups. | 37 |
| Hepatitis A vaccine | Systematic review of 17 studies (immunosuppressed patients | Heterogenous responses; lowest immune response in transplanted patients using multiple immunosuppressive drugs, especially after only 1 dose of vaccine. | 38 |
| Hepatitis B vaccine | Systematic review of 7 studies (SOT patients): | Low response rates in adult SOT recipients (6.7% to 36%) but higher response rate in the paediatric trials (63.6% to 100%) | 32 |
| Streptococcus pneumonia vaccine | Systematic review of 9 studies (SOT patients): | Overall response ranged from 32% to 100% with comparable responses in the control group, if included. | 32 |
| Tetanus vaccine | Systematic review of 6 studies (SOT patients): | High rate of responders in SOT recipients with conventional immunosuppression with no significant difference to healthy controls. Lower response in patients with anti-CD20 treatment. | 32 |
| Diphteria vaccine | Systematic review of 4 studies (SOT patients): | Comparable response rates in SOT recipients and controls. | 32 |
SOT, solid organ transplantation; MMF, mycophenolate mofetil.