Department of Pediatrics, Division of General Pediatrics, Children's Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
Department of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition Unit, Children's Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
Am J Transplant. 2019 Mar;19(3):844-854. doi: 10.1111/ajt.15101. Epub 2018 Oct 1.
Live-attenuated vaccines are currently contraindicated in solid-organ transplant recipients. However, the risk of vaccine-preventable infections is lifelong, and can be particularly severe after transplantation. In this prospective interventional national cohort study, 44 pediatric liver transplant recipients with measles IgG antibodies <150 IU/L (below seroprotection threshold) received measles-mumps-rubella vaccine (MMR) at a median of 6.3 years posttransplantation (interquartile range, 4.0 to 10.9). A maximum of two additional doses were administered in nonresponders or when seroprotection was lost. Vaccine responses occurred in 98% (95% confidence interval [CI], 88-100) of patients. Seroprotection at 1-, 2-, and 3-year follow-up reached 62% (95% CI, 45-78), 86% (95% CI, 70-95), and 89% (95% CI, 67-99), respectively. All patients responded appropriately to the booster dose(s). Vaccinations were well tolerated and no serious adverse event attributable to vaccination was identified during the 8-week follow-up period (or later), using a multimodal approach including standardized telephone interviews, diarized side effect reporting, and monitoring of vaccinal virus shedding. We conclude that live attenuated MMR vaccine can be administered in liver transplant recipients fulfilling specific eligibility criteria (>1 year posttransplantation, low immunosuppression, lymphocyte count ≥0.75 G/L), inducing seroprotection in most subjects. (Clinicaltrials.gov number NCT01770119).
活疫苗目前不适用于实体器官移植受者。然而，疫苗可预防感染的风险是终身的，并且在移植后可能特别严重。在这项前瞻性干预性全国队列研究中，44 名麻疹 IgG 抗体 <150IU/L（低于血清保护阈值）的小儿肝移植受者在移植后中位数 6.3 年（四分位距，4.0 至 10.9）接受麻疹-腮腺炎-风疹疫苗（MMR）。在无应答者或失去血清保护时，最多可额外给予两剂。98%（95%置信区间[CI]，88-100）的患者出现疫苗反应。1、2 和 3 年随访时的血清保护率分别达到 62%（95%CI，45-78）、86%（95%CI，70-95）和 89%（95%CI，67-99）。所有患者对加强剂量均有适当反应。接种疫苗耐受性良好，在 8 周随访期间（或之后），使用包括标准化电话访谈、日记式副作用报告和疫苗病毒脱落监测在内的多模式方法，未发现与接种相关的严重不良事件。我们得出结论，活减毒 MMR 疫苗可在符合特定资格标准的肝移植受者中使用（>1 年移植后，免疫抑制程度低，淋巴细胞计数≥0.75 G/L），可诱导大多数受者产生血清保护。（临床试验.gov 编号：NCT01770119）。
