Efficacy of influenza vaccination in adult liver transplant recipients

To assess the efficacy of influenza vaccination in immunocompromised adult liver transplant (LTx) recipients, the serum antibody responses of 61 of th ese patients and 35 liver cirrhosis patients with those of 45 of their heal thy spouses were compared, after one and two vaccinations with a commercial trivalent subunit influenza vaccine. In addition, virus-specific prolifera tive T-cell responses were measured in LTx recipients and their healthy spo uses. In all three study groups, significant rises in geometric mean antibo dy titers were observed for all three antigens after one vaccination. These titers did not continue to increase significantly after the second vaccina tion in patients with cirrhosis and control subjects but did rise for LTx r ecipients. The overall antibody response to all three influenza virus strai ns proved to be significantly lower in the LTx recipients than in the group of healthy subjects after both one and two vaccinations. More than 68% of the LTx recipients developed hemagglutination-inhibiting serum antibody tit ers greater than or equal to 40 against all three vaccine strains after the first vaccination and more than 80% after the second vaccination. These fi ndings correlated with the T-cell responses determined for the group of LTx recipients and healthy control individuals. Testing of the respective seru m samples against influenza virus A/Sydney/5/97, which circulated in the 19 97-1998 influenza season and showed a considerable mismatch with the vaccin e strain A/Nanchang/933/95, indicated that such a mismatch may have signifi cant consequences for vaccine efficacy, especially for LTx recipients. Coll ectively the data show that LTx recipients can be vaccinated effectively ag ainst influenza despite immunosuppressive therapy. A two-dose vaccination r egimen improved vaccination efficacy in LTx recipients. Whether transplant patients generally benefit from a two-dose vaccination regimen should be ev aluated further. J. Med. Virol. 67:85-93, 2000. (C) 2000 Wiley-Liss, Inc.