title: Long-term Follow-up of Humoral Immune Status in Adult Lung Transplant Recipients.
abstract: Lung transplant recipients have an increased risk for infections in the posttransplant period due to immunosuppressive therapy. Protection against infections can be achieved through vaccination, but the optimal vaccination schedule in lung transplant recipients is unknown. Data on long-term immunological follow up and vaccination responses after lung transplantation are scarce.
  
  
  
  Here we present long-term immunological follow up of a cohort of 55 lung transplant recipients. This includes detailed antibody responses after 23-valent pneumococcal polysaccharide vaccination (23vPPV).
  
  
  
  All patients were vaccinated with 23vPPV before transplantation. Median follow-up after transplantation was 6.6 years (379 patient-years). After transplantation, there is a significant decrease of all immunoglobulins, IgG subclasses and pneumococcal polysaccharide antibodies. After the first year posttransplantation, there is a gradual increase of all immunoglobulins and IgG subclasses, but values were always significantly lower than in the pretransplant period. After a median of 4.4 years posttransplantation, patients were revaccinated with 23vPPV. The pneumococcal polysaccharide antibody response was impaired in 87% of patients (ie, antibody titer above cutoff and twofold increase between pre and postvaccination values for <70% of serotypes).
  
  
  
  We found that impairment of humoral immunity was most outspoken in the first year after lung transplantation. Immunoglobulin levels remain decreased several years after transplantation and the response to pneumococcal polysaccharide vaccine was significantly lower posttransplantation compared to the pretransplantation response. However, most patients did show a partial response to vaccination. Based on our results, revaccination with pneumococcal vaccines after transplantation should be considered 1 year after transplantation.
authors.affiliation: 1 Department of Pulmonology, St. Antonius Hospital, Nieuwegein, The Netherlands. 2 Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands. 3 Department of Medical Microbiology and Immunology, St. Antonius Hospital, Nieuwegein, The Netherlands. 4 Department of Science, University College Roosevelt, Middelburg, The Netherlands.
authors.forename: Diana A
authors.initials: DA
authors.lastname: van Kessel
authors.forename: Thijs W
authors.initials: TW
authors.lastname: Hoffman
authors.forename: Johanna M
authors.initials: JM
authors.lastname: Kwakkel-van Erp
authors.forename: Erik-Jan D
authors.initials: ED
authors.lastname: Oudijk
authors.forename: Pieter
authors.initials: P
authors.lastname: Zanen
authors.forename: Ger T
authors.initials: GT
authors.lastname: Rijkers
authors.forename: Jan C
authors.initials: JC
authors.lastname: Grutters
mesh_terms: D000328:Adult; D000907:Antibodies, Bacterial / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006801:Humans; D056724:Immunity, Humoral; D007115:Immunization Schedule; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D022242:Pneumococcal Vaccines / Q000627:therapeutic use*; D012189:Retrospective Studies; D013296:Streptococcus pneumoniae / Q000276:immunology*; D013997:Time Factors; D066027:Transplant Recipients; D014611:Vaccination / Q000379:methods*; D055815:Young Adult
chemical_list: D000907:Antibodies, Bacterial; D022242:Pneumococcal Vaccines