title: Immune status assessment in adult lung transplant candidates.
abstract: Lung transplant recipients have an increased susceptibility to a variety of infections due to immunosuppressive therapy. Current guidelines recommend pneumococcal and other vaccinations, prior to lung transplantation to protect against post-transplant infections, but measurement of the antibody response to vaccination is not advised. Immune status investigation in lung transplant candidates, including the response to pneumococcal polysaccharide vaccination, has not been described.
  
  
  
  Immune status investigation, including measurement of immunoglobulins, complement and the response to 23-valent pneumococcal polysaccharide vaccination (23vPPV) was performed in 81 adult lung transplant candidates.
  
  
  
  Eighteen patients had low IgG levels and 32 patients had low IgG1 and/or IgG2 levels. After vaccination with 23vPPV the median antibody concentration of all serotypes increased significantly. Fifty-two patients had protective IgG-post-vaccination antibody levels to at least 10 serotypes. Twenty-nine patients had an impaired response to 23vPPV.
  
  
  
  In conclusion, a significant proportion of our cohort of lung transplant candidates had one or more abnormalities in the immune status. It is likely that these patients have an increased risk for infections after transplantation. Revaccination, including measurement of antibody response, and possibly antibody replacement therapy should be considered to minimize infection risk.
authors.affiliation: Department of Pulmonology, St. Antonius Hospital, Nieuwegein, The Netherlands; Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: d.kessel@antoniusziekenhuis.nl.
authors.forename: Diana A
authors.initials: DA
authors.lastname: van Kessel
authors.affiliation: Department of Pulmonology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Thijs W
authors.initials: TW
authors.lastname: Hoffman
authors.affiliation: Department of Medical Microbiology and Immunology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Heleen
authors.initials: H
authors.lastname: van Velzen-Blad
authors.affiliation: Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Ed A
authors.initials: EA
authors.lastname: van de Graaf
authors.affiliation: Department of Pulmonology, St. Antonius Hospital, Nieuwegein, The Netherlands; Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Jan C
authors.initials: JC
authors.lastname: Grutters
authors.affiliation: Department of Medical Microbiology and Immunology, St. Antonius Hospital, Nieuwegein, The Netherlands; Department of Science, University College Roosevelt, Middelburg, The Netherlands.
authors.forename: Ger T
authors.initials: GT
authors.lastname: Rijkers
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D056724:Immunity, Humoral; D016867:Immunocompromised Host; D007136:Immunoglobulins / Q000097:blood*; D007239:Infections / Q000209:etiology / Q000276:immunology*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D015166:Monitoring, Immunologic / Q000379:methods; D022242:Pneumococcal Vaccines / Q000276:immunology*; D011183:Postoperative Complications / Q000276:immunology*; D012306:Risk; D066027:Transplant Recipients; D014611:Vaccination; D014850:Waiting Lists; D055815:Young Adult
chemical_list: D007136:Immunoglobulins; D022242:Pneumococcal Vaccines
keywords: Immune status investigation; Lung transplant candidates; Pneumococcal polysaccharide vaccination