Decreased antibody response to influenza vaccination in kidney transplant recipients: a prospective cohort study.
BACKGROUND
Antibody response to the inactivated influenza vaccine is not well described in kidney transplant recipients administered newer, but commonly used, immunosuppression medications. We hypothesized that kidney transplant recipient participants administered tacrolimus-based regimens would have decreased antibody response compared with healthy controls.


METHODS
Prospective cohort study of 53 kidney transplant recipients and 106 healthy control participants during the 2006-2007 influenza season. All participants received standard inactivated influenza vaccine.


METHODS
Kidney transplant recipients administered tacrolimus-based regimens at a single academic medical center and healthy controls.


METHODS
Presence of kidney transplant.


RESULTS
Proportion of participants achieving seroresponse (4-fold increase in antibody titer) and seroprotection (antibody titer > or = 1:32) 1 month after vaccination.


METHODS
Antibody titers before and 1 month after vaccination by means of hemagglutinin inhibition assays for influenza types A/H1N1, A/H3N2, and B.


RESULTS
A smaller proportion of the transplantation group compared with the healthy control group developed the primary outcomes of seroresponse or seroprotection for all 3 influenza types at 1 month after vaccination. The response to influenza type A/H3N2 was statistically different; the transplantation group had 69% decreased odds of developing seroresponse (95% confidence interval, 0.16 to 0.62; P = 0.001) and 78% decreased odds of developing seroprotection (95% confidence interval, 0.09 to 0.53; P = 0.001) compared with healthy controls. When participants less than 6 months from the time of transplantation were considered, this group had a significantly decreased response to the vaccine compared with healthy controls.


CONCLUSIONS
Decreased sample size, potential for confounders, outcome measure used is the standard but does not give information about vaccine efficacy.


CONCLUSIONS
Kidney transplant recipients, especially within 6 months of transplantation, had diminished antibody response to the 2006-2007 inactivated influenza vaccine.
Birdwell
Kelly A
KA
Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA.
Ikizler
Mine R
MR
Sannella
Edith C
EC
Wang
Li
L
Byrne
Daniel W
DW
Ikizler
T Alp
TA
Wright
Peter F
PF
D000328:Adult; D000914:Antibodies, Viral / Q000097:blood*; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007109:Immunity / Q000187:drug effects; D007166:Immunosuppressive Agents / Q000494:pharmacology; D007252:Influenza Vaccines / Q000276:immunology* / Q000627:therapeutic use*; D007251:Influenza, Human / Q000276:immunology* / Q000517:prevention & control*; D007674:Kidney Diseases / Q000601:surgery; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009975:Orthomyxoviridae / Q000276:immunology; D011446:Prospective Studies; D016559:Tacrolimus / Q000494:pharmacology; D013997:Time Factors; D016896:Treatment Outcome
D000914:Antibodies, Viral; D007166:Immunosuppressive Agents; D007252:Influenza Vaccines; D016559:Tacrolimus