title: Mycophenolate and lower graft function reduce the seroresponse of kidney transplant recipients to pandemic H1N1 vaccination.
abstract: In late 2009 transplant organizations recommended that kidney recipients be vaccinated for pandemic H1N1 influenza (pH1N1); however, the vaccine efficacy was unknown. We had offered a monovalent non-adjuvanted pH1N1 vaccine to transplant recipients. Here we compared the pre- and post-vaccination seroresponses of 151 transplant recipients to that of 71 hemodialysis patients and 30 healthy controls. Baseline seroprotection was similar between groups but was significantly different at 1 month (44, 56, and 87%, respectively). Seroconversion was significantly less common for transplant recipients (32%) than dialysis patients (45%) and healthy controls (77%). After adjusting for age and gender, dialysis patients were significantly more likely (2.7-fold) to achieve new seroprotection than transplant recipients. The likelihood of seroprotection in transplant recipients was significantly reduced by mycophenolate use (adjusted odds ratio 0.24), in a dose-dependent manner, and by reduced eGFR (adjusted odds ratio 0.16 for worst to best). Seroprotection and geometric mean antibody titers increased substantially in 49 transplant recipients who subsequently received the 2010 seasonal influenza vaccine. Thus, patients requiring renal replacement therapy had reduced seroresponses to vaccination with the monovalent vaccine compared with healthy controls. Transplant recipient responses were further reduced if they were receiving mycophenolate or had significantly lower graft function.
authors.affiliation: Department of Nephrology, Monash Medical Centre, Clayton, Victoria, Australia.
authors.forename: William R
authors.initials: WR
authors.lastname: Mulley
authors.forename: Kumar
authors.initials: K
authors.lastname: Visvanathan
authors.forename: Aeron C
authors.initials: AC
authors.lastname: Hurt
authors.forename: Fiona G
authors.initials: FG
authors.lastname: Brown
authors.forename: Kevan R
authors.initials: KR
authors.lastname: Polkinghorne
authors.forename: Tasoula
authors.initials: T
authors.lastname: Mastorakos
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Lewicki
authors.forename: Rhonda L
authors.initials: RL
authors.lastname: Stuart
authors.forename: Sven-Jean
authors.initials: SJ
authors.lastname: Tan
authors.forename: Roy
authors.initials: R
authors.lastname: Chean
authors.forename: Peter G
authors.initials: PG
authors.lastname: Kerr
authors.forename: John
authors.initials: J
authors.lastname: Kanellis
mesh_terms: D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D053118:Influenza A Virus, H1N1 Subtype / Q000276:immunology* / Q000472:pathogenicity; D007252:Influenza Vaccines / Q000276:immunology*; D007251:Influenza, Human / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control* / Q000821:virology; D007668:Kidney / Q000187:drug effects / Q000276:immunology / Q000503:physiopathology / Q000601:surgery*; D007674:Kidney Diseases / Q000097:blood / Q000276:immunology* / Q000503:physiopathology / Q000628:therapy; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives*; D016017:Odds Ratio; D058873:Pandemics; D011446:Prospective Studies; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014611:Vaccination; D014739:Victoria / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D007166:Immunosuppressive Agents; D007252:Influenza Vaccines; D009173:Mycophenolic Acid