Skip to main content

Advertisement

SpringerLink
Log in

Impfungen vor und nach Nierentransplantation

Vaccination before and after kidney transplantation

  • Leitthema
  • Published:
Der Nephrologe Aims and scope

Zusammenfassung

Die Prävention von Infektionen durch Impfung gehört zu den grundlegenden Aufgaben der Pädiatrie und ist insbesondere auf dem Gebiet der Organtransplantation von entscheidender Bedeutung. Zur Rejektionsprophylaxe müssen sich Transplantierte in der Regel einer lebenslangen medikamentösen Immunsuppression unterziehen. Infolgedessen zeigen inaktivierte Totimpfstoffe nach Transplantation häufig eine deutlich herabgesetzte Immunogenität, während attenuierte Lebendvakzine die Gefahr disseminierter Infektionen bergen und daher nach Transplantation nicht zu empfehlen sind. Aus diesem Grund sollte der Impfstatus insbesondere von Kindern und Jugendlichen, aber ggf. auch von Erwachsenen auf der Warteliste bereits vor Transplantation komplettiert werden. Neben der Einhaltung der Impfempfehlungen der Ständigen Impfkommission des Robert Koch-Instituts (STIKO) sind zusätzliche Impfungen gemäß den Leitlinien der American Society of Transplantation (AST) und der Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group erforderlich. Hierzu zählen u. a. diejenige gegen Hepatitis A und die jährliche Influenzaimpfung. Nach Transplantation sind attenuierte Lebendimpfstoffe, beispielsweise gegen Masern, Mumps, Röteln, Varizellen, Rotaviren, Gelbfieber, Influenza (intranasaler Impfstoff) und Poliomyelitis (oraler Impfstoff), kontraindiziert. Eine Lebendimpfung nach Transplantation sollte im Expositionsfall nur nach sorgfältiger Nutzen-Risiko-Analyse erwogen werden und die Ausnahme von der Regel bleiben. Regelmäßige Impftiterbestimmungen und ggf. Auffrischimpfungen mit inaktivierten Totimpfstoffen nach Transplantation sind hingegen zu empfehlen. Darüber hinaus sollten enge Kontaktpersonen wie Familienmitglieder und medizinisches Personal zum Schutz von nierentransplantierten Patienten einen kompletten Impfstatus im Sinne einer sog. Herdenimmunität aufweisen.

Abstract

Prevention of systemic infections by effective vaccination constitutes an essential issue in pediatrics and is of vital importance especially in the field of organ transplantation. To avoid allograft rejection, transplant recipients usually require life-long immunosuppressive medication, which often leads to a reduced immunogenicity of inactivated vaccines, whereas attenuated live virus vaccines bear the risk of disseminated infections and are therefore contraindicated after transplantation. For these reasons, the vaccination status particularly of pediatric and adolescent patients and, if necessary, also of adults on the waiting list, should be completed before transplantation. Apart from the routine vaccination recommendations issued by the German Standing Committee on Vaccination (STIKO) of the Robert Koch Institute, additional vaccinations according to the guidelines published by the American Society of Transplantation (AST) and the Kidney Disease: Improving Global Outcomes (KDIGO) transplantation work group are necessary. These include hepatitis A and the annual vaccination against influenza. After transplantation, attenuated live virus vaccines, for example, against measles, mumps, rubella, varicella, rotavirus, yellow fever, influenza (intranasal vaccine) and poliovirus (oral vaccine) are contraindicated. A live attenuated vaccination after transplantation should be considered only in cases of exposure and after a careful risk-benefit assessment and remain an exception to the rule. Vaccination titers should be regularly measured after transplantation and, in addition, booster vaccinations with inactivated vaccines are recommended. Furthermore, healthcare workers and close contacts, such as family members of transplant patients should be fully immunized to ensure protection of pediatric kidney allograft recipients through so-called herd immunity.

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

Literatur

  1. Danziger-Isakov L, Kumar D (2013) Vaccination in solid organ transplantation. Am J Transplant 13(Suppl 4):311–317

    Article  CAS  PubMed  Google Scholar 

  2. Koch-Institut R (2014) Empfehlungen der Ständigen Impfkommission (STIKO) am Robert Koch-Institut/Stand: August 2014. Epidemiol Bull 34:305–340

    Google Scholar 

  3. Journal A (2009) KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant 9(Suppl 3):S1–S155

    Google Scholar 

  4. Sester M, Gärtner BC, Girndt M, Sester U (2008) Vaccination of the solid organ transplant recipient. Transplant Rev 22:274–284

    Article  Google Scholar 

  5. Pittet LF, Posfay-Barbe KM (2013) Immunization in transplantation: review of the recent literature. Curr Opin Organ Transplant 18:543–548

    Article  CAS  PubMed  Google Scholar 

  6. Danerseau AM, Robinson JL (2008) Efficacy and safety of measles, mumps, rubella and varicella live viral vaccines in transplant recipients receiving immunosuppressive drugs. World J Pediatr 4:254–258

    Article  PubMed  Google Scholar 

  7. Verolet CM, Posfay-Barbe KM (2015) Live virus vaccines in transplantation: friend or foe? Curr Infect Dis Rep 17:472

    Article  PubMed  Google Scholar 

  8. Kraft JN, Shaw JC (2006) Varicella infection caused by Oka strain vaccine in a heart transplant recipient. Arch Dermatol 142:943–945

    Article  PubMed  Google Scholar 

  9. Pergam SA (2009) Varicella zoster virus (VZV) in solid organ. Am J Transplant 9:138–146

    Article  Google Scholar 

  10. Levitsky J, Doucette K, AST Infectious Diseases Community of Practice (2009) Viral hepatitis in solid organ transplant recipients. Am J Transplant 9:S116–S130

    Article  PubMed  Google Scholar 

  11. Chin-Hong PV, Kwak EJ (2013) Human papillomavirus in solid organ transplantation. Am J Transplant 13(Suppl 4):189–200

    Article  CAS  PubMed  Google Scholar 

  12. Herrero R, González P, Markowitz LE (2015) Present status of human papillomavirus vaccine development and implementation. Lancet Oncol 16:e206–e216

    Article  CAS  PubMed  Google Scholar 

  13. Schiller JT, Müller M (2015) Next generation prophylactic human papillomavirus vaccines. Lancet Oncol 16:e217–e225

    Article  CAS  PubMed  Google Scholar 

  14. Schellenbacher C, Kwak K, Fink D et al (2013) Efficacy of RG1-VLP vaccination against infections with genital and cutaneous human papillomaviruses. J Invest Dermatol 133:2706–2713

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  15. Nailescu C, Shew M, Slaven J, Saha C (2015) The response to human papillomavirus vaccination in pediatric patients before and after kidney transplantation. Pediatr Transplant 19:80

    Google Scholar 

  16. Legendre CM, Licht C, Muus P et al (2013) Terminal complement inhibitor eculizumab in atypical hemolytic-uremic syndrome. N Engl J Med 368:2169–2181

    Article  CAS  PubMed  Google Scholar 

  17. Kotton CN, Hibberd PL (2013) Travel medicine and transplant tourism in solid organ transplantation. Am J Transplant 13:337–347

    Article  CAS  PubMed  Google Scholar 

  18. Mallory RM, Yi T, Ambrose CS (2011) Shedding of Ann Arbor strain live attenuated influenza vaccine virus in children 6–59 months of age. Vaccine 29:4322–4327

    Article  PubMed  Google Scholar 

  19. Smith CK, McNeal MM, Meyer NR et al (2011) Rotavirus shedding in premature infants following first immunization. Vaccine 29:8141–8146

    Article  CAS  PubMed  Google Scholar 

  20. Emery VC (2013) Human herpesvirus vaccines and future directions. Am J Transplant 13:79–86

    Article  CAS  PubMed  Google Scholar 

  21. Cohen JI (2000) Epstein-Barr virus infection. N Engl J Med 343:481–492

    Article  CAS  PubMed  Google Scholar 

  22. Höcker B, Fickenscher H, Delecluse HJ et al (2013) Epidemiology and morbidity of Epstein-Barr virus infection in pediatric renal transplant recipients: a multicenter, prospective study. Clin Infect Dis 56:84–92

    Article  PubMed  Google Scholar 

  23. Cohen JI (2015) Epstein-barr virus vaccines. Clin Transl Immunol 4:e32

    Article  Google Scholar 

  24. Kharfan-Dabaja MA, Boeckh M, Wilck MB et al (2012) A novel therapeutic cytomegalovirus DNA vaccine in allogeneic haemopoietic stem-cell transplantation: a randomised, double-blind, placebo-controlled, phase 2 trial. Lancet Infect Dis 12:290–299

    Article  CAS  PubMed  Google Scholar 

  25. Fishman JA, Emery V, Freeman R et al (2007) Cytomegalovirus in transplantation – challenging the status quo. Clin Transplant 21:149–158

    Article  PubMed  Google Scholar 

  26. ClinicalTrials (2015) A Study to Evaluate the Efficacy and Safety of a Vaccine, ASP0113, in Cytomegalovirus (CMV)-Seronegative Kidney Transplant Recipients Receiving an Organ From a CMV-Seropositive Donor (A service of the U.S. National Institutes of Health). https://clinicaltrials.gov/show/NCT01974206

    Google Scholar 

  27. Chaves TSS, Pereira LM, De Santos SS et al (2008) Evaluation of the vaccination status in pediatric renal transplant recipients. Pediatr Transplant 12:432–435

    Article  CAS  PubMed  Google Scholar 

  28. Genc G, Ozkaya O, Aygun C et al (2012) Vaccination status of children considered for renal transplant: missed opportunities for vaccine preventable diseases. Exp Clin Transplant 10:314–318

    Article  PubMed  Google Scholar 

  29. Prelog M, Pohl M, Ermisch B et al (2007) Demand for evaluation of vaccination antibody titers in children considered for renal transplantation. Pediatr Transplant 11:73–76

    Article  CAS  PubMed  Google Scholar 

  30. Plotnicki L, Kohl CD, Höcker B et al (2013) The CERTAIN Registry: a novel, web-based registry and research platform for pediatric renal transplantation in Europe. Transplant Proc 45:1414–1417

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik Kinderheilkunde I, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Deutschland

    B. Höcker, M. Aguilar & B. Tönshoff

Authors
  1. B. Höcker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Aguilar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B. Tönshoff
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Höcker.

Ethics declarations

Interessenkonflikt

B. Höcker, M. Aguilar und B. Tönshoff geben an, dass kein Interessenkonflikt besteht. Die Autoren des Artikels weisen ausdrücklich darauf hin, dass die vorliegenden Empfehlungen den behandelnden Arzt nicht von der Verantwortung für seine therapeutischen Entscheidungen entbinden, die er fallweise für jeden einzelnen Patienten treffen muss.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Additional information

Redaktion

D. E. Müller-Wiefel, Hamburg

B. Tönshoff, Heidelberg

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Höcker, B., Aguilar, M. & Tönshoff, B. Impfungen vor und nach Nierentransplantation. Nephrologe 10, 488–496 (2015). https://doi.org/10.1007/s11560-015-0008-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11560-015-0008-3

Schlüsselwörter

Keywords

Search

Navigation