Fairhead T, Hendren E, Tinckam K, Rose C, Sherlock C H, Shi L, Crowcroft N S, Gubbay J B, Landsberg D, Knoll G, Gill J, Kumar D
Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
Transpl Infect Dis. 2012 Dec;14(6):575-83. doi: 10.1111/tid.12006. Epub 2012 Sep 24.
Seasonal and pandemic influenza virus infections in renal transplant patients are associated with poor outcomes. During the pandemic of 2009-2010, the AS03-adjuvanted monovalent H1N1 influenza vaccine was recommended for transplant recipients, although its immunogenicity in this population was unknown. We sought to determine the safety and immunogenicity of an adjuvant-containing vaccine against pandemic influenza A H1N1 2009 (pH1N1) administered to kidney transplant recipients.
We prospectively enrolled 124 adult kidney transplant recipients in the fall of 2009 at two transplant centers. Cohort 1 (n = 42) was assessed before and after pH1N1 immunization, while Cohort 2 (n = 82) was only assessed post immunization. Humoral response was measured by the hemagglutination inhibition assay. Vaccine safety was assessed by adverse event reporting, graft function, and human leukocyte antigen (HLA) alloantibody measurements.
Cohort 1 had a low rate of baseline seroprotection to pH1N1 (7%) and a low rate of seroprotection after immunization (31%). No patient <6 months post transplant (n = 5) achieved seroprotection. Seroprotection rate was greater in patients receiving double as compared with triple immunosuppression (80% vs. 24%, P = 0.01). In Cohort 2, post-immunization seroprotection was 35%. In both cohorts, no confirmed cases of pH1N1 infection occurred. No difference was seen in estimated glomerular filtration rate before (54.3 mL/min/1.73 m(2) ) and after (53.8 mL/min/1.73 m(2) ) immunization, and no acute rejections had occurred after immunization at last follow-up. In Cohort 1, 11.9% of patients developed new anti-HLA antibodies.
An adjuvant-containing vaccine to pH1N1 provided poor seroprotection in renal transplant recipients. Receiving triple immunosuppression was associated with a poor seroresponse. Vaccination appeared safe, but some patients developed new anti-HLA antibodies post vaccination. Alternative strategies to improve vaccine responses are necessary.
肾移植患者感染季节性流感病毒和大流行性流感病毒与不良预后相关。在2009 - 2010年大流行期间，推荐为移植受者接种含AS03佐剂的单价H1N1流感疫苗，尽管其在该人群中的免疫原性尚不清楚。我们试图确定接种含佐剂的2009年甲型H1N1大流行性流感（pH1N1）疫苗对肾移植受者的安全性和免疫原性。
2009年秋季，我们在两个移植中心前瞻性纳入了124名成年肾移植受者。队列1（n = 42）在接种pH1N1疫苗前后进行评估，而队列2（n = 82）仅在接种后进行评估。通过血凝抑制试验测量体液免疫反应。通过不良事件报告、移植肾功能和人类白细胞抗原（HLA）同种抗体测量评估疫苗安全性。
队列1对pH1N1的基线血清保护率较低（7%），接种后血清保护率也较低（31%）。移植后<6个月的患者（n = 5）无一人获得血清保护。接受双重免疫抑制的患者血清保护率高于接受三重免疫抑制的患者（80%对24%，P = 0.01）。在队列2中，接种后血清保护率为35%。在两个队列中，均未发生确诊的pH1N1感染病例。接种前（54.3 mL/min/1.73 m²）和接种后（53.8 mL/min/1.73 m²）的估计肾小球滤过率无差异，最后一次随访时接种后未发生急性排斥反应。在队列1中，11.9%的患者产生了新的抗HLA抗体。
含佐剂的pH1N1疫苗在肾移植受者中提供的血清保护较差。接受三重免疫抑制与血清反应不良相关。疫苗接种似乎是安全的，但一些患者接种后产生了新的抗HLA抗体。有必要采取替代策略来改善疫苗反应。
