ROUTINE IMMUNIZATIONS IN ADULT RENAL-TRANSPLANT RECIPIENTS

Background, Vaccination guidelines for transplant recipients include r egular boosters of tetanus, diphtheria, and inactivated polio vaccine, but there are few published data on the efficacy of these vaccines in patients receiving immunosuppressive therapy. Methods. Serum antibody values were evaluated before and 4 weeks after tetanus, diphtheria, a nd inactivated polio vaccination in 164 renal transplant recipients co mpared with healthy controls, Twelve months later, antibody levels wer e evaluated in 55 patients. Results. Prebooster tetanus antitoxin valu es were lower in transplant recipients than in controls, AU patients d eveloped protective tetanus antibody levels (greater than or equal to 0.01 IU/ml) after vaccination. After 12 months, serum antibodies had d ecreased, but all patients maintained protective values. Diphtheria an titoxin titers before and after booster vaccination were lower in pati ents than in controls: 88.5% of patients and 96.2% of controls develop ed protective diphtheria antibody values, Twelve months after vaccinat ion, diphtheria antitoxin values were below the protective level (0.1 IU/ml) in 38% of patients, Prebooster antibody values to poliovirus ty pes 1 and 3 were comparable in patients and controls, whereas antibodi es to poliovirus type 2 were lower in transplant recipients, Seroprote ction rates and geometric mean antibody titers after vaccination were equivalent between the two groups for all three poliovirus types, No d ifference was observed in antibody levels between patients on differen t immunosuppressive drug regimens, Adverse reactions were significantl y less often reported by transplant recipients. Conclusions. In transp lant recipients, tetanus and inactivated polio vaccinations are well t olerated and induce protective antibody levels; diphtheria vaccination as currently recommended is less effective and protective antitoxin v alues decrease rapidly in these patients within 1 year after vaccinati on.