title: Heterologous Immune Responses to Influenza Vaccine in Kidney Transplant Recipients.
abstract: Influenza vaccine is known to have suboptimal immunogenicity in transplant recipients. Despite this, influenza vaccine may have the added benefit of inducing a cross-reactive immune response to viral strains not found in the vaccine. This is termed "heterologous immunity" and has not been assessed previously in transplant patients. Pre- and postvaccination sera from kidney transplant recipients (n = 60) immunized with the 2012-2013 adjuvanted or nonadjuvanted influenza vaccine underwent testing by hemagglutination inhibition assay for strains not present in vaccine: A/New Caledonia/20/99 (H1N1), A/Texas/50/2012 (H3N2) and B/Brisbane/60/2008. The geometric mean titer of antibody to heterologous strains increased after vaccine (H1N1: 80.0 to 136.1, p < 0.001; H3N2: 23.3 to 77.3, p < 0.001; B: 13.3 to 19.5, p < 0.001). Seroconversion rates were 16.7%, 41.7%, and 13.3%, respectively. No differences in heterologous response were seen in the adjuvanted versus nonadjuvanted groups. Patients were more likely to seroconvert for a cross-reactive antigen if they seroconverted for the specific vaccine antigen. Seroconversion to heterologous A/H3N2, for example, was 84.0% for homologous H3N2 seroconverters versus 11.4% for nonseroconverters (p < 0.001). This study provides novel evidence that transplant recipients are able to mount significant cross-protective responses to influenza vaccine that may be an additional, previously unknown benefit of immunization.
authors.affiliation: Multi-Organ Transplant Program, University Health Network, Toronto, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Kumar
authors.affiliation: Multi-Organ Transplant Program, University Health Network, Toronto, Canada.
authors.forename: V H
authors.initials: VH
authors.lastname: Ferreira
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Campbell
authors.affiliation: Public Health England, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Hoschler
authors.affiliation: Multi-Organ Transplant Program, University Health Network, Toronto, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Humar
mesh_terms: D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood / Q000276:immunology; D015331:Cohort Studies; D003429:Cross Reactions; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000276:immunology; D006085:Graft Survival / Q000276:immunology; D006385:Hemagglutination Inhibition Tests; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000276:immunology*; D053122:Influenza A Virus, H3N2 Subtype / Q000276:immunology*; D007252:Influenza Vaccines / Q000627:therapeutic use*; D007251:Influenza, Human / Q000276:immunology* / Q000517:prevention & control / Q000821:virology; D007676:Kidney Failure, Chronic / Q000276:immunology* / Q000601:surgery / Q000821:virology; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D066027:Transplant Recipients; D014611:Vaccination; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D007252:Influenza Vaccines
keywords: clinical research/practice; cross-protection; immunogenicity; immunosuppression; infection and infectious agents; infectious disease; serology; vaccine; viral: influenza