Influence of renal replacement therapy on immune response after one and two doses of the A(H1N1) pdm09 vaccine.
BACKGROUND
Patients with end-stage renal disease have a reduced response to vaccination because of the general suppression of the immune system associated with uraemia.


OBJECTIVE
We evaluated the immune response and differential factors in the immunogenicity to an adjuvanted A(H1N1) pdm09 vaccine (Pandemrix(®) ) in four populations of renal patients after one and two doses of vaccine. PATIENTS METHODS: 151 patients were included in this study: 58 chronic haemodialysis patients, 52 renal allograft recipients, 14 peritoneal dialysis patients and 27 patients with advanced chronic kidney disease in preparation for kidney replacement therapy. Influenza-specific antibody levels were measured by monitoring A(H1N1) pdm09 titres using a haemagglutination inhibition assay.


RESULTS
The seroconversion rate at 42 days after two vaccine doses was 80% in the haemodialysis group, 64.9% in the renal allograft recipients group, 100% in the advanced chronic kidney disease group and 71.4% in the peritoneal dialysis group (P = 0.041).


CONCLUSIONS
Immune response to two doses of the influenza A H1N1 vaccine is dissimilar in the four renal conditions, confirming that seroprotection in pre-dialysis, haemodialysis and peritoneal dialysis is similar to that in the general population vaccinated with one dose. In contrast, renal transplant recipients with good allograft function showed inadequate protection and triple immunosuppressive therapy including calcineurin inhibitors, mycophenolate and steroids negatively influenced seroconversion after vaccination in renal recipients.
Department of Nephrology and Renal Transplantation, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain. lfquinta@clinic.ub.es
Luis F
LF
Quintana
Nuria
N
Serra
Patricia
P
De Molina-Llauradó
Miquel
M
Blasco
Mikel
M
Martinez
Begoña
B
Campos
Jose M
JM
Bayas
Tomás
T
Pumarola
Josep M
JM
Campistol
D000328:Adult; D000914:Antibodies, Viral / Q000276:immunology; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000235:genetics / Q000276:immunology*; D007252:Influenza Vaccines / Q000008:administration & dosage / Q000235:genetics / Q000276:immunology*; D007251:Influenza, Human / Q000150:complications / Q000276:immunology* / Q000517:prevention & control / Q000821:virology; D007668:Kidney / Q000276:immunology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000276:immunology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D017582:Renal Replacement Therapy
D000914:Antibodies, Viral; D007252:Influenza Vaccines