Clinical Immunotherapeutics

, Volume 3, Issue 5, pp 330–337 | Cite as

Immunisation of Transplant Recipients

  • Per Ljungman
  • Viera Hammarström
Practical Therapeutics
First Online:
  • 5 Downloads

Summary

An increasing number of patients become long term survivors after bone marrow and solid organ transplantation. These patients are at risk for infectious complications, some of which can be prevented by immunisation. Therefore, knowledge of the patients’ specific immune status to antigens such as poliovirus and tetanus toxoid is important.

Most recipients of allogeneic bone marrow transplantation will lose immunity to tetanus toxoid, diphtheria toxoid and poliovirus during long term follow-up. Thus, a reimmunisation programme is necessary against these infections. Immunisation can also be considered against infections with influenza virus, Haemophilus influenzae, pneumococci and hepatitis B virus. Recipients of autologous bone marrow transplants are also at an increased risk of losing immunity to tetanus toxoid and poliovirus, and therefore a reimmunisation programme should be considered.

Recipients of solid organ transplants should be considered for immunisation against hepatitis B, influenza A and B, H. influenzae and pneumococci. There is no information available concerning long term immunity to tetanus toxoid and poliovirus in recipients of solid organ transplants.

Keywords

Influenza Transplant Recipient Measle Varicella Zoster Virus Biliary Atresia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Ljungman P, Fridell E, Lönnqvist B, et al. Efficacy and safety of vaccination of marrow transplant recipients with a live attenuated measles, mumps, and rubella vaccine. J Infect Dis 1989; 159: 610–5PubMedCrossRefGoogle Scholar
  2. 2.
    Lum L, Seigneuret M, Storb R. The transfer of antigen-specific humoral immunity from marrow donors to marrow recipients. J Clin Immunol 1986; 6: 1–8CrossRefGoogle Scholar
  3. 3.
    Lum L. The kinetics of immune reconstitution after human marrow transplantation. Blood 1987; 69: 369–80PubMedGoogle Scholar
  4. 4.
    Lum L, Noges J, Beatty P, et al. Transfer of specific immunity in marrow recipients given HLA-mismatched, T cell-depleted, or HLA-identical marrow grafts. Bone Marrow Transplant 1988; 3: 399–406PubMedGoogle Scholar
  5. 5.
    Lum L. Effects of acute and chronic GVHD on immune recovery after BMT. In: Burakoff SJ, Deeg HJ, Ferrara J, et al., editors. Graft-versus-host disease. New York: Marcel Dekker, 1990: 369–80Google Scholar
  6. 6.
    Saxon A, Mitsuyaso R, Stevens R, et al. Transfer of specific immune responses after bone marrow transplantation. J Clin Invest 1986; 78: 959–67PubMedCrossRefGoogle Scholar
  7. 7.
    Wahren B, Gahrton G, Linde A, et al. Transfer and persistence of viral antibody-producing cells in bone marrow transplantation. J Infect Dis 1984; 150: 358–65PubMedCrossRefGoogle Scholar
  8. 8.
    Witherspoon R, Storb R, Ochs HD, et al. Recovery of antibody production in human allogeneic marrow graft recipients: influence of time posttransplantation, the presence or absence of chronic graft-versus-host disease, and antithymocyte globulin treatment. Blood 1981; 58: 360–8PubMedGoogle Scholar
  9. 9.
    Witherspoon R, Matthews D, Storb R, et al. Recovery of in vivo cellular immunity after human marrow grafting: influence of time postgrafting and acute graft-versus-host disease. Transplantation 1984; 37: 145–50PubMedCrossRefGoogle Scholar
  10. 10.
    Wimperis J, Brenner M, Prentice H, et al. Transfer of a functioning humoral immune system in transplantation of T-lymphocyte-depleted bone marrow. Lancet 1986; 1: 339–43PubMedCrossRefGoogle Scholar
  11. 11.
    Ljungman P, Wiklund HM, Duraj V, et al. Response to tetanus toxoid immunization after allogeneic bone marrow transplantation. J Infect Dis 1990; 162: 496–500PubMedCrossRefGoogle Scholar
  12. 12.
    Ljungman P, Duraj V, Magnius L. Response to immunization against polio after allogeneic marrow transplantation. Bone Marrow Transplant 1991; 7: 89–93PubMedGoogle Scholar
  13. 13.
    Engelhard D, Handsher R, Naparstek E, et al. Immune responses to polio vaccination in bone marrow transplant recipients. Bone Marrow Transplant 1991; 8: 295–300PubMedGoogle Scholar
  14. 14.
    Ljungman P, Levensohn-Fuchs I, Hammarström V, et al. Long-term immunity to measles, mumps and rubella after allogeneic bone marrow transplantation. Blood 1994; 84: 657–64PubMedGoogle Scholar
  15. 15.
    Lum L, Munn N, Schanfield M, et al. The detection of specific antibody formation to recall antigens after human bone marrow transplantation. Blood 1986; 67: 582–7PubMedGoogle Scholar
  16. 16.
    Plotkin SA, Starr S, Friedman H, et al. Effect of Towne live virus vaccine on cytomegalovirus disease after renal transplant: a controlled trial. Ann Intern Med 1991; 114: 525–31PubMedGoogle Scholar
  17. 17.
    Adler SP. Development and clinical status of cytomegalovirus vaccines. Clin Immunother 1994; 2(1): 1–6CrossRefGoogle Scholar
  18. 18.
    Aschan J, Ringdén O, Ljungman P, et al. Influenza B in transplant patients. Scand J Infect Dis 1989; 21: 349–50PubMedCrossRefGoogle Scholar
  19. 19.
    Ljungman P, Gleaves CA, Meyers JD. Respiratory virus infection in immunocompromised patients. Bone Marrow Transplant 1989; 4: 35–40PubMedGoogle Scholar
  20. 20.
    Whimbey E, Elting L, Couch R, et al. Influenza A virus infections among hospitalized adult bone marrow transplant recipients. Bone Marrow Transplant 1994; 13: 437–40PubMedGoogle Scholar
  21. 21.
    Ljungman P, Andersson J, Aschan J, et al. Influenza A in immunocompromised patients. Clin Infect Dis 1993; 17: 244–7PubMedCrossRefGoogle Scholar
  22. 22.
    Ilan Y, Nagler A, Adler R, et al. Ablation of persistent hepatitis B by bone marrow transplantation from a hepatitis B-immune donor. Gastroenterology 1993; 104: 1818–21PubMedGoogle Scholar
  23. 23.
    Ilan Y, Nagler A, Adler R, et al. Adoptive transfer of immunity to hepatitis B virus after T cell-depleted allogeneic bone marrow transplantation. Hepatology 1993; 18: 246–52PubMedGoogle Scholar
  24. 24.
    Ilan Y, Nagler A, Shouval D, et al. Development of antibodies to hepatitis B virus surface antigen in bone marrow transplant recipient following treatment with peripheral blood lymphocytes from immunized donors. J Clin Exp Immunol 1994; 97: 299–302CrossRefGoogle Scholar
  25. 25.
    Dumyati G, Treanor JJ. Practical use of vaccines to prevent infection with influenza virus and Streptococcus pneumoniae. Clin Immunother 1994; 2(4): 248–60CrossRefGoogle Scholar
  26. 26.
    Cordonnier C, Bernaudin J, Bierling P, et al. Pulmonary complications occurring after allogeneic bone marrow transplantation: a study of 130 consecutive transplanted patients. Cancer 1986; 58: 1047–54PubMedCrossRefGoogle Scholar
  27. 27.
    Aucotourier P, Barra A, Intrator I, et al. Long lasting IgG subclass and antibacterial polysaccharide antibody deficiency after allogeneic bone marrow transplantation. Blood 1987; 70: 779–85Google Scholar
  28. 28.
    Winston D, Schiffman L, Wang D, et al. Pneumococcal infection after human bone marrow transplantation. Ann Intern Med 1979; 91: 835–41PubMedGoogle Scholar
  29. 29.
    Lortan J, Vellodi A, Jurges E, et al. Class- and subclass-specific pneumococcal antibody levels and response to immunization after bone marrow transplantation. Clin Exp Immunol 1992; 88: 512–9PubMedCrossRefGoogle Scholar
  30. 30.
    Hammarström V, Pauksen K, Azinge J, et al. The influence of graft versus host reaction on the response to pneumococcal vaccination in bone marrow transplant patients. J Supportive Care Cancer 1993; 1: 195–199CrossRefGoogle Scholar
  31. 31.
    Guinan E, Molrine D, Antin J, et al. Polysaccharide conjugate vaccine response in bone marrow transplant recipients. Transplantation 1994; 57: 677–84PubMedCrossRefGoogle Scholar
  32. 32.
    Barra A, Cordonnier C, Preziosi M, et al. Immunogenicity of Haemophilus influenzae type b conjugate vaccine in allogeneic bone marrow recipients. J Infect Dis 1992; 166: 1021–8PubMedCrossRefGoogle Scholar
  33. 33.
    Engelhard D, Nagler A, Hardan I, et al. Antibody response to a two-dose regimen of influenza vaccine in allogeneic T cell-depleted and autologous BMT recipients. Bone Marrow Transplant 1993; 11: 1–5PubMedGoogle Scholar
  34. 34.
    Prager J, Baumert A, Thilo W, et al. Untersuchungen zur Kinetik der Impfantikörper gegen Tetanustoxoid, Diphterietoxoid, Masern-virus, Poliomyelitis-virus und Pneumokokken nach allogener und autologer Knochenmarktransplantaton und Wiederhholungsimpfung. Teil 3: Kinetik der Impfantikörper gegen Tetanustoxoid nach allogener und autologer Knochenmarktransplantation und kombinierter Wiederholungsimpfung gegen Diphterie and Tetanus. Kinderarztl Prax 1992; 60: 230–8PubMedGoogle Scholar
  35. 35.
    Pauksen K, Duraj V, Ljungman P, et al. Immunity to and immunization against measles, rubella and mumps in patients after autologous bone marrow transplantation. Bone Marrow Transplant 1992; 9: 427–32PubMedGoogle Scholar
  36. 36.
    Pauksen K, Hammarström V, Ljungman P, et al. Immunity to poliovirus and immunization with inactivated poliovaccine after autologous bone marrow transplantation. Clin Infect Dis 1994; 18: 547–52PubMedCrossRefGoogle Scholar
  37. 37.
    Bárány P, Fehrman-Ekholm I. Immunological aspects of haemodialysis. Clin Immunother 1994; 1(6): 469–80CrossRefGoogle Scholar
  38. 38.
    Balfour HJ, Chace B, Stapleton J, et al. A randomized, placebo-controlled trial of oral acyclovir for the prevention of cytomegalovirus disease in recipients of renal allografts. N Engl J Med 1989; 320: 1381–7PubMedCrossRefGoogle Scholar
  39. 39.
    Crosnier J, Junges P, Courouce A-M, et al. Randomized placebo-controlled trial of hepatitis B surface antigen vaccine in French haemodialysis units. II. Haemodialysis patients. Lancet 1981; 2: 797–800CrossRefGoogle Scholar
  40. 40.
    Stevens C, Alter H, Taylor P, et al. Hepatitis B virus vaccine in patients receiving hemodialysis: immunogenicity and efficacy. N Engl J Med 1984; 311: 496–501PubMedCrossRefGoogle Scholar
  41. 41.
    Sokal E, Ulla L, Otte J. Hepatitis B vaccine response before and after transplantation in 55 extrahepatic biliary atresia children. Dig Dis Sci 1992; 37: 1250–2PubMedCrossRefGoogle Scholar
  42. 42.
    Turik M, Markowitz S. A successful regimen for the prevention of seroconversion after transplantation of a heart positive for hepatitis B surface antigen. J Heart Lung Transplant 1992; 11: 781–3PubMedGoogle Scholar
  43. 43.
    Carey W, Pimentel R, Westweer M, et al. Failure of hepatitis B immunization in liver transplant patients: results of a prospective trial. Am J Gastroenterol 1990; 85: 1590–2PubMedGoogle Scholar
  44. 44.
    Broyer M, Boudailliez B. Varicella vaccine in children with chronic renal insufficiency. Postgrad Med J 1985; 61Suppl. 4: 103–6PubMedGoogle Scholar
  45. 45.
    Linnemann CJ, First M, Schiffman G. Response to pneumococcal vaccine in renal transplant and hemodialysis patients. Arch Intern Med 1981; 141: 1637–40PubMedCrossRefGoogle Scholar
  46. 46.
    Wagner D, Wagenbreth I, Stachan-Kunstyr R, et al. Failure of vaccination against hepatitis B with Gen H-B-Vax-D in immunosuppressed heart transplant patients. J Infect Dis 1992; 166: 1021–8CrossRefGoogle Scholar
  47. 47.
    Grob P, Binswanger U, Zaruba K, et al. Immunogenicity of a hepatitis B subunit vaccine in hemodialysis and in renal transplant recipients. Antiviral Res 1983; 3: 43–52PubMedCrossRefGoogle Scholar
  48. 48.
    Center for Disease Control. Recommendation of the Immunization Practices Advisory Committee (ACIP). MMWR Morb Mortal Wkly Rep 1991; 37: 361–73Google Scholar
  49. 49.
    Versluis D, Beyer W, Masurel N, et al. Impairment of the immune response to influenza vaccination in renal transplant recipients by cyclosporine, but not azathioprine. Transplantation 1986; 42: 376–9PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 1995

Authors and Affiliations

  • Per Ljungman
    • 1
  • Viera Hammarström
    • 1
  1. 1.Department of MedicineHuddinge University Hospital, Karolinska InstituteHuddingeSweden

Personalised recommendations