Skip to main content

Advertisement

SpringerLink
Log in

Vaccine-Preventable Illness Leads to Adverse Outcomes in Liver Transplant Recipients

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Liver transplant recipients (LTR) and patients with chronic liver disease (CLD) are at an increased risk of infections.

Aims

The objective of our study was to assess the incidence, and impact of vaccine preventable illness (VPI) on outcomes in LTR.

Methods

National Inpatient Sample (NIS) 2016–2020 was used to identify adults (age > 18) hospitalized LTR using ICD-10 codes. Data were collected on patient demographics, hospital characteristics, etiology of liver disease, hepatic decompensations and outcomes. Patients were stratified into two groups based on the presence or absence of VPI. Multivariate logistic regression analysis was performed to identify the association between VPI and outcomes.

Results

Out of 170,650 hospitalized LTR, 13.5% of the patients had VPI. The most common VPI was noted to be influenza (10.7%), followed by pneumococcal infection (2.7%). Incidence of mortality (6.9% vs. 1.6%, p < 0.001), ICU admissions (14.3% vs. 3.4%, p < 0.001), and acute kidney injury (AKI) (43.7% vs 37.35%, p < 0.001) was higher in the VPI group.

Conclusion

More than 13% of the LT hospitalizations had concomitant VPI. VPI in LTR was associated with worse outcomes. Our data suggests the need to identify factors associated with reduced vaccination rates and identify strategies to improve vaccination rates and responses in these patients.

Graphical Abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Tuchendler E, Tuchendler PK, Madej G. Immunodeficiency caused by cirrhosis. Clin Exp Hepatol 2018;4:158–164.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Gustot T, Durand F, Lebrec D, Vincent JL, Moreau R. Severe sepsis in cirrhosis. Hepatology (Baltimore, Md.) 2009;50:2022–2033.

    Article  CAS  PubMed  Google Scholar 

  3. Gustot T, Fernandez J, Garcia E et al. Clinical course of acute-on-chronic liver failure syndrome and effects on prognosis. Hepatology 2015;2:243–252. https://doi.org/10.1002/hep.27849.

    Article  Google Scholar 

  4. Jalan-Sakrikar N, Brevini T, Huebert RC, Sampaziotis F. Organoids and regenerative hepatology. Hepatology (Baltimore, Md) 2023;77:305.

    Article  PubMed  Google Scholar 

  5. Cindy Young. (2022, January 11). All-time records again set in 2021 for organ transplants, organ donation from deceased donors. UNOS. Retrieved April 29, 2023, from https://unos.org/news/2021-all-time-records-organ-transplants-deceased-donor-donation/

  6. Pilar Hernandez MD, Martin P, Simkins J. Infectious complications after liver transplantation. Gastroenterol Hepatol 2015;11:741–753.

    Google Scholar 

  7. Romero FA, Razonable RR. Infections in liver transplant recipients. World J Hepatol 2011;3:83–92.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Rolak S, Said A, German R, Hayney MS, Caldera F. Optimizing immunization strategies in adult patients with chronic liver disease and liver transplant recipients. Gastroenterol Hepatol 2022;18:196–206.

    Google Scholar 

  9. Caballero-Marcos A, Salcedo M, Alonso-Fernández R, Rodríguez-Perálvarez M, Spanish Society of Liver Transplantation (SETH) et al. Changes in humoral immune response after SARS-CoV-2 infection in liver transplant recipients compared to immunocompetent patients. Am J Transplant 2021;21:2876–2884. https://doi.org/10.1111/ajt.16599.

    Article  CAS  PubMed  Google Scholar 

  10. Rubin LG, Levin MJ, Ljungman P, Davies EG, Infectious Diseases Society of America, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis 2014;58:44–100.

    Article  Google Scholar 

  11. Danziger-Isakov L, Kumar D. Vaccination of solid organ transplant candidates and recipients: guidelines from the American society of transplantation infectious diseases community of practice. Clin Transplant. 2019;33:e13563.

    Article  PubMed  Google Scholar 

  12. Feldman AG, Atkinson K, Wilson K, Kumar D. Under-immunization of the solid organ transplant population: an urgent problem with potential digital health solutions. Am J Transplant 2020;20:34–39.

    Article  PubMed  Google Scholar 

  13. Kim YJ, Kim SI. Vaccination strategies in patients with solid organ transplant: Evidences and future perspectives. Clin Exp Vaccine Res 2016;5:125–131.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Laue T, Demir Z, Debray D, Cananzi M et al. Under-vaccination in pediatric liver transplant candidates with acute and chronic liver disease-a retrospective observational study of the European Reference Network TransplantChild. Children (Basel, Switzerland) 2021;8:675. https://doi.org/10.3390/children8080675.

    Article  PubMed  Google Scholar 

  15. Danziger-Isakov L, Kumar D, AST Infectious Diseases Community of Practice. Vaccination in solid organ transplantation. Am J Transplant 2013;13:311–317. https://doi.org/10.1111/ajt.12122.

    Article  CAS  PubMed  Google Scholar 

  16. Invasive Pneumococcal Disease in Solid Organ Transplant Recipients—10-Year Prospective Population SurveillanceKumar, D. et al.American Journal of Transplantation, Volume 7, Issue 5, 1209 - 1214

  17. HCUP National Inpatient Sample (NIS). Healthcare cost and utilization project (HCUP). 2016–2019. Agency for healthcare research and quality. Rockville, MD.

  18. Elixhauser Comorbidity Software Refined for ICD-10-CM Healthcare Cost and Utilization Project (HCUP) . October 2021. Agency for healthcare research and quality. Rockville, MD.

  19. Ison MG. Influenza prevention and treatment in transplant recipients and immunocompromised hosts. Influenza Other Respir Viruses 2013;7:60–66. https://doi.org/10.1111/irv.12170.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Duchini A, Hendry RM, Redfield DC, Pockros PJ. Influenza infection in patients before and after liver transplantation. Liver Transpl. 2000;6:531–542. https://doi.org/10.1053/jlts.2000.9738.

    Article  CAS  PubMed  Google Scholar 

  21. Kumar D, Ferreira VH, Blumberg E, Silveira F et al. A 5-year prospective multicenter evaluation of influenza infection in transplant recipients. Clin Infect Dis 2018;67:1322–1329. https://doi.org/10.1093/cid/ciy294.

    Article  PubMed  Google Scholar 

  22. Weltermann B, Herwig A, Dehnen D, Herzer K. Vaccination status of pneumococcal and other vaccines in 444 liver transplant patients compared to a representative population sample. Ann Transplant. 2016;21:200–207. https://doi.org/10.12659/aot.896436.

    Article  PubMed  Google Scholar 

  23. Kumar D, Chen MH, Wong G et al. A randomized, double-blind, placebo-controlled trial to evaluate the prime-boost strategy for pneumococcal vaccination in adult liver transplant recipients. Clin Infect Dis. 2008;47:885–892. https://doi.org/10.1086/591537.

    Article  PubMed  Google Scholar 

  24. McCashland TM, Preheim LC, Gentry MJ. Pneumococcal vaccine response in cirrhosis and liver transplantation. J Infect Dis. 2000;181:757–760. https://doi.org/10.1086/315245.

    Article  CAS  PubMed  Google Scholar 

  25. Kumar D, Humar A, Plevneshi A, Green K, Prasad GV, Siegal D, Toronto Invasive Bacterial Diseases Network, McGeer A. Invasive pneumococcal disease in solid organ transplant recipients–10-year prospective population surveillance. Am J Transplant 2007;7:1209–1214.

    Article  CAS  PubMed  Google Scholar 

  26. Rezahosseini O, Møller DL, Sørensen SS, Perch M et al. An observational prospective cohort study of incidence and outcome of streptococcus pneumoniae and Hemophilus influenzae infections in adult solid organ transplant recipients. Microorganisms 2021;9:1371. https://doi.org/10.3390/microorganisms9071371.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Levitsky J, Kalil A, Meza JL, Hurst GE, Freifeld A. Herpes zoster infection after liver transplantation: a case-control study. Liver Transpl 2005;11:320–325.

    Article  PubMed  Google Scholar 

  28. Kim W, Kim S, Oh J, Jeong YJ et al. Incidence and risk factors for herpes zoster after adult liver transplantation. Ann Surg Treat Res. 2019;96:95–99. https://doi.org/10.4174/astr.2019.96.2.95.

    Article  PubMed  Google Scholar 

  29. Pergam SA, Forsberg CW, Boeckh MJ et al. Herpes zoster incidence in a multicenter cohort of solid organ transplant recipients. Transpl Infect Dis. 2011;13:15–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Hirzel C, L’Huillier AG, Ferreira VH, Marinelli T et al. Safety and immunogenicity of adjuvanted recombinant subunit herpes zoster vaccine in lung transplant recipients. Am J Transpl 2021;21:2246–2253. https://doi.org/10.1111/ajt.16534.

    Article  CAS  Google Scholar 

  31. Vink P, Ramon Torrell JM, Sanchez Fructuoso A, Kim SJ, Z-041 Study Group et al. Immunogenicity and safety of the adjuvanted recombinant zoster vaccine in chronically immunosuppressed adults following renal transplant: a phase 3, Randomized Clinical Trial. Clin Infect Dis 2020;70:181–190. https://doi.org/10.1093/cid/ciz177.

    Article  CAS  PubMed  Google Scholar 

  32. Anderson TC, Masters NB, Guo A, Shepersky L et al. Use of recombinant zoster vaccine in immunocompromised adults aged ≥19 years: recommendations of the Advisory Committee on Immunization Practices—United States. MMWR 2022;71:80–84. https://doi.org/10.15585/mmwr.mm7103a2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Wang L, Verschuuren EA, van Leer-Buter CC, Bakker SJ, De Joode AA, Westra J, Bos NA. Herpes zoster and immunogenicity and safety of zoster vaccines in transplant patients: a narrative review of the literature. Front Immunol 2018;9:1632. https://doi.org/10.3389/fimmu.2018.01632.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Dooling KL, Guo A, Patel M et al. Recommendations of the Advisory Committee on Immunization Practices for use of herpes zoster vaccines. MMWR Morb Mortal Wkly Rep 2018;67:103–8. https://doi.org/10.15585/mmwr.mm6703a5.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Harpaz R, Ortega-Sanchez IR, Seward JF, Advisory Committee on Immunization Practices; CDC. Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2008;57(No. RR-5):1–30.

  36. Walti LN, Mugglin C, Mombelli M, Manuel O, Swiss Transplant Cohort Study et al. Vaccine-preventable infections among solid organ transplant recipients in Switzerland. JAMA Netw Open 2023;6:687.

    Article  Google Scholar 

  37. Arentoft NS, Møller DL, Knudsen AD, Abdulovski R et al. Influenza in liver and kidney transplant recipients: incidence and outcomes. Microbiol Spectr 2023;11:e0322622.

    Article  PubMed  Google Scholar 

  38. Stockwell MS, Fiks AG. Utilizing health information technology to improve vaccine communication and coverage. Hum Vaccines Immunother 2013;9:1802–1811.

    Article  Google Scholar 

  39. Wilson K, Atkinson KM, Westeinde J. Apps for immunization: Leveraging mobile devices to place the individual at the center of care. Hum Vaccin Immunother 2015;11:2395–2399.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Szilagyi PG, Bordley C, Vann JC, Chelminski A, Kraus RM, Margolis PA et al. Effect of patient reminder/recall interventions on immunization rates: a review. Jama 2000;284:1820–1827.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Hepatology, Liver Institute Northwest, 3216 NE 45Th Pl, Suite 212, Seattle, WA, 98105, USA

    Aalam Sohal

  2. Graduate Program in Public Health, Icahn School of Medicine, Mount Sinai, New York, NY, USA

    Isha Kohli

  3. Department of Internal Medicine, University of California, San Francisco, Fresno, CA, USA

    Hunza Chaudhry

  4. Dayanand Medical College and Hospital, Ludhiana, India

    Ishandeep Singh, Kirti Arora & Shivam Kalra

  5. Ross University of Medical Sciences, Miramar, FL, USA

    Dino Dukovic

  6. Department of Gastroenterology and Hepatology, University of California, San Francisco, Fresno, CA, USA

    Marina Roytman

Authors
  1. Aalam Sohal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Isha Kohli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hunza Chaudhry
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ishandeep Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kirti Arora
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shivam Kalra
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dino Dukovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Marina Roytman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aalam Sohal.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 16 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sohal, A., Kohli, I., Chaudhry, H. et al. Vaccine-Preventable Illness Leads to Adverse Outcomes in Liver Transplant Recipients. Dig Dis Sci 69, 588–595 (2024). https://doi.org/10.1007/s10620-023-08202-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-023-08202-x

Keywords

Search

Navigation