title: Routine immunizations in adult renal transplant recipients.
abstract: BACKGROUND
  Vaccination guidelines for transplant recipients include regular boosters of tetanus, diphtheria, and inactivated polio vaccine, but there are few published data on the efficacy of these vaccines in patients receiving immunosuppressive therapy.
  
  
  METHODS
  Serum antibody values were evaluated before and 4 weeks after tetanus, diphtheria, and inactivated polio vaccination in 164 renal transplant recipients compared with healthy controls. Twelve months later, antibody levels were evaluated in 55 patients.
  
  
  RESULTS
  Prebooster tetanus antitoxin values were lower in transplant recipients than in controls. All patients developed protective tetanus antibody levels (> or = 0.01 IU/ml) after vaccination. After 12 months, serum antibodies had decreased, but all patients maintained protective values. Diphtheria antitoxin titers before and after booster vaccination were lower in patients than in controls: 88.5% of patients and 96.2% of controls developed protective diphtheria antibody values. Twelve months after vaccination, diphtheria antitoxin values were below the protective level (0.1 IU/ml) in 38% of patients. Prebooster antibody values to poliovirus types 1 and 3 were comparable in patients and controls, whereas antibodies to poliovirus type 2 were lower in transplant recipients. Seroprotection rates and geometric mean antibody titers after vaccination were equivalent between the two groups for all three poliovirus types. No difference was observed in antibody levels between patients on different immunosuppressive drug regimens. Adverse reactions were significantly less often reported by transplant recipients.
  
  
  CONCLUSIONS
  In transplant recipients, tetanus and inactivated polio vaccinations are well tolerated and induce protective antibody levels; diphtheria vaccination as currently recommended is less effective and protective antitoxin values decrease rapidly in these patients within 1 year after vaccination.
authors.affiliation: Institute of Tropical Medicine, University Hospital Charite, Berlin, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Huzly
authors.forename: S
authors.initials: S
authors.lastname: Neifer
authors.forename: P
authors.initials: P
authors.lastname: Reinke
authors.forename: K
authors.initials: K
authors.lastname: Schröder
authors.forename: C
authors.initials: C
authors.lastname: Schönfeld
authors.forename: T
authors.initials: T
authors.lastname: Hofmann
authors.forename: U
authors.initials: U
authors.lastname: Bienzle
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000917:Antibody Formation; D015331:Cohort Studies; D004168:Diphtheria Toxoid; D005260:Female; D006801:Humans; D007115:Immunization Schedule; D007117:Immunization, Secondary; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011054:Poliovirus Vaccine, Inactivated; D012044:Regression Analysis; D013745:Tetanus Toxoid; D015164:Vaccines, Inactivated
chemical_list: D004168:Diphtheria Toxoid; D007166:Immunosuppressive Agents; D011054:Poliovirus Vaccine, Inactivated; D013745:Tetanus Toxoid; D015164:Vaccines, Inactivated