title: Updated data on effective and safe immunizations with live-attenuated vaccines for children after living donor liver transplantation.
abstract: BACKGROUND
  Although immunizations using live-attenuated vaccines are not recommended for children post-liver transplant due to their theoretical risks, they will inevitably encounter vaccine-preventable viral diseases upon returning to real-life situations. The window of opportunity for vaccination is usually limited prior to transplantation because these children often have unstable disease courses. Also, vaccine immunity does not always persist after transplantation.
  
  
  METHODS
  Beginning in 2002, subcutaneous immunizations with four individual live-attenuated vaccines (measles, rubella, varicella, and mumps) to pediatric patients following living donor liver transplantation (LDLT) were performed for those who fulfilled the clinical criteria, including humoral and cell-mediated immunity. Written informed consent was collected. We included the study on 70 immunizations for 18 cases that we reported in 2008 (Shinjoh et al., 2008).
  
  
  RESULTS
  A total of 196 immunizations were administered to 48 pediatric post-LDLT recipients. Of these, 144 were first immunizations and 52 were repeated immunizations following LDLT. The seroconversion rates at the first dose for measles (AIK-C), rubella (TO-336), varicella (Oka), and mumps (Hoshino) were 100% (36/36), 100% (35/35), 70% (23/33), and 75% (24/32), respectively. Antibody levels did not fall over time in patients immunized with rubella vaccine. Three mild cases of breakthrough varicella were observed. Two cases with transient parotid gland swelling were observed after mumps immunization. Two admissions because of fever at 2-3 weeks after the measles vaccine were reported but the patients had no symptoms of measles.
  
  
  CONCLUSIONS
  Immunizations using selected live-attenuated vaccines were safe and effective for post-LDLT children who were not severely immunosuppressed. However, with the exception of rubella, repeated immunization may be necessary.
authors.affiliation: Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. Electronic address: m-shinjo@z2.keio.jp.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Shinjoh
authors.affiliation: Department of Pediatric Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. Electronic address: hoshino@z7.keio.jp.
authors.forename: Ken
authors.initials: K
authors.lastname: Hoshino
authors.affiliation: Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. Electronic address: ttakahashi@z3.keio.jp.
authors.forename: Takao
authors.initials: T
authors.lastname: Takahashi
authors.affiliation: Laboratory of Viral Infection, Kitasato Institutes for Life Sciences, 5-9-1 Shirokane Minato-ku, Tokyo 108-8642, Japan. Electronic address: tetsuo-N@Lisci.Kitasato-U.Ac.Jp.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Nakayama
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007114:Immunization / Q000009:adverse effects* / Q000379:methods*; D007223:Infant; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D016896:Treatment Outcome; D014613:Vaccines, Attenuated / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology; D014765:Viral Vaccines / Q000008:administration & dosage / Q000009:adverse effects* / Q000276:immunology*
chemical_list: D014613:Vaccines, Attenuated; D014765:Viral Vaccines
keywords: Child; Immunization; Live-attenuated vaccine; Liver transplantation