Effects of the influenza vaccine on pediatric kidney transplant outcomes

Megan Camerino, Scott Jackson, Srinath Chinnakotla, Priya Verghese

Research output: Contribution to journalArticle

Abstract

The influenza vaccine is critical for preventing influenza-related complications in transplant patients. Previous studies demonstrated de novo donor-specific antibody formation and rejection following the influenza vaccination. This risk has not been adequately assessed in the pediatric population. We performed a single-center retrospective analysis of 187 unique pediatric kidney transplant recipients, transplanted from January 1, 2006, to December 31, 2015, assessing for an association of the influenza vaccination with various transplant outcomes. The influenza vaccine was received by 125 of 187 patients within the first year post-transplant. Using log-rank tests and Kaplan-Meier curves, vaccinated patients had a significantly lower risk of mortality (P = 0.048). There were no differences in death-censored graft survival (P = 0.253), graft survival (P = 0.098), or rejection (P = 0.195) between vaccinated and unvaccinated groups. To address the problem of multiple exposures for a yearly vaccine, Cox proportional hazards regression was utilized with post-transplant vaccination status considered as a time-dependent covariate; analyses were performed using both a 360- and 180-day vaccination period following any post-transplant influenza vaccination. In this model, being vaccinated did not result in a significant difference in mortality (HR 0.90 [0.16, 5.15], P = 0.91), death-censored graft survival (HR 0.70 [0.31, 1.58], P = 0.39), graft survival (HR 0.69 [0.32, 1.49], P = 0.34), or rejection (HR 0.67 [0.37, 1.19], P = 0.17). Eight patients developed de novo donor-specific antibodies following the first post-transplant influenza vaccination; three then developed biopsy-proven rejection. These results suggest influenza vaccination is safe in pediatric kidney transplant recipients, and larger prospective studies are required to conclusively confirm our findings.

Original languageEnglish (US)
Article numbere13354
JournalPediatric transplantation
Volume23
Issue number2
DOIs
StatePublished - Mar 1 2019

Fingerprint

Influenza Vaccines
Vaccination
Human Influenza
Pediatrics
Transplants
Kidney
Graft Survival
Tissue Donors
Mortality
Kaplan-Meier Estimate
Antibody Formation
Vaccines
Prospective Studies
Biopsy
Antibodies
Population

Keywords

  • influenza
  • kidney transplant
  • outcomes
  • pediatric
  • vaccination

PubMed: MeSH publication types

  • Journal Article

Cite this

Effects of the influenza vaccine on pediatric kidney transplant outcomes. / Camerino, Megan; Jackson, Scott; Chinnakotla, Srinath; Verghese, Priya.

In: Pediatric transplantation, Vol. 23, No. 2, e13354, 01.03.2019.

Research output: Contribution to journalArticle

Camerino, Megan ; Jackson, Scott ; Chinnakotla, Srinath ; Verghese, Priya. / Effects of the influenza vaccine on pediatric kidney transplant outcomes. In: Pediatric transplantation. 2019 ; Vol. 23, No. 2.
@article{96c95a66ee804628b3165dea2d9297e6,
title = "Effects of the influenza vaccine on pediatric kidney transplant outcomes",
abstract = "The influenza vaccine is critical for preventing influenza-related complications in transplant patients. Previous studies demonstrated de novo donor-specific antibody formation and rejection following the influenza vaccination. This risk has not been adequately assessed in the pediatric population. We performed a single-center retrospective analysis of 187 unique pediatric kidney transplant recipients, transplanted from January 1, 2006, to December 31, 2015, assessing for an association of the influenza vaccination with various transplant outcomes. The influenza vaccine was received by 125 of 187 patients within the first year post-transplant. Using log-rank tests and Kaplan-Meier curves, vaccinated patients had a significantly lower risk of mortality (P = 0.048). There were no differences in death-censored graft survival (P = 0.253), graft survival (P = 0.098), or rejection (P = 0.195) between vaccinated and unvaccinated groups. To address the problem of multiple exposures for a yearly vaccine, Cox proportional hazards regression was utilized with post-transplant vaccination status considered as a time-dependent covariate; analyses were performed using both a 360- and 180-day vaccination period following any post-transplant influenza vaccination. In this model, being vaccinated did not result in a significant difference in mortality (HR 0.90 [0.16, 5.15], P = 0.91), death-censored graft survival (HR 0.70 [0.31, 1.58], P = 0.39), graft survival (HR 0.69 [0.32, 1.49], P = 0.34), or rejection (HR 0.67 [0.37, 1.19], P = 0.17). Eight patients developed de novo donor-specific antibodies following the first post-transplant influenza vaccination; three then developed biopsy-proven rejection. These results suggest influenza vaccination is safe in pediatric kidney transplant recipients, and larger prospective studies are required to conclusively confirm our findings.",
keywords = "influenza, kidney transplant, outcomes, pediatric, vaccination",
author = "Megan Camerino and Scott Jackson and Srinath Chinnakotla and Priya Verghese",
year = "2019",
month = "3",
day = "1",
doi = "10.1111/petr.13354",
language = "English (US)",
volume = "23",
journal = "Pediatric Transplantation",
issn = "1397-3142",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - Effects of the influenza vaccine on pediatric kidney transplant outcomes

AU - Camerino, Megan

AU - Jackson, Scott

AU - Chinnakotla, Srinath

AU - Verghese, Priya

PY - 2019/3/1

Y1 - 2019/3/1

N2 - The influenza vaccine is critical for preventing influenza-related complications in transplant patients. Previous studies demonstrated de novo donor-specific antibody formation and rejection following the influenza vaccination. This risk has not been adequately assessed in the pediatric population. We performed a single-center retrospective analysis of 187 unique pediatric kidney transplant recipients, transplanted from January 1, 2006, to December 31, 2015, assessing for an association of the influenza vaccination with various transplant outcomes. The influenza vaccine was received by 125 of 187 patients within the first year post-transplant. Using log-rank tests and Kaplan-Meier curves, vaccinated patients had a significantly lower risk of mortality (P = 0.048). There were no differences in death-censored graft survival (P = 0.253), graft survival (P = 0.098), or rejection (P = 0.195) between vaccinated and unvaccinated groups. To address the problem of multiple exposures for a yearly vaccine, Cox proportional hazards regression was utilized with post-transplant vaccination status considered as a time-dependent covariate; analyses were performed using both a 360- and 180-day vaccination period following any post-transplant influenza vaccination. In this model, being vaccinated did not result in a significant difference in mortality (HR 0.90 [0.16, 5.15], P = 0.91), death-censored graft survival (HR 0.70 [0.31, 1.58], P = 0.39), graft survival (HR 0.69 [0.32, 1.49], P = 0.34), or rejection (HR 0.67 [0.37, 1.19], P = 0.17). Eight patients developed de novo donor-specific antibodies following the first post-transplant influenza vaccination; three then developed biopsy-proven rejection. These results suggest influenza vaccination is safe in pediatric kidney transplant recipients, and larger prospective studies are required to conclusively confirm our findings.

AB - The influenza vaccine is critical for preventing influenza-related complications in transplant patients. Previous studies demonstrated de novo donor-specific antibody formation and rejection following the influenza vaccination. This risk has not been adequately assessed in the pediatric population. We performed a single-center retrospective analysis of 187 unique pediatric kidney transplant recipients, transplanted from January 1, 2006, to December 31, 2015, assessing for an association of the influenza vaccination with various transplant outcomes. The influenza vaccine was received by 125 of 187 patients within the first year post-transplant. Using log-rank tests and Kaplan-Meier curves, vaccinated patients had a significantly lower risk of mortality (P = 0.048). There were no differences in death-censored graft survival (P = 0.253), graft survival (P = 0.098), or rejection (P = 0.195) between vaccinated and unvaccinated groups. To address the problem of multiple exposures for a yearly vaccine, Cox proportional hazards regression was utilized with post-transplant vaccination status considered as a time-dependent covariate; analyses were performed using both a 360- and 180-day vaccination period following any post-transplant influenza vaccination. In this model, being vaccinated did not result in a significant difference in mortality (HR 0.90 [0.16, 5.15], P = 0.91), death-censored graft survival (HR 0.70 [0.31, 1.58], P = 0.39), graft survival (HR 0.69 [0.32, 1.49], P = 0.34), or rejection (HR 0.67 [0.37, 1.19], P = 0.17). Eight patients developed de novo donor-specific antibodies following the first post-transplant influenza vaccination; three then developed biopsy-proven rejection. These results suggest influenza vaccination is safe in pediatric kidney transplant recipients, and larger prospective studies are required to conclusively confirm our findings.

KW - influenza

KW - kidney transplant

KW - outcomes

KW - pediatric

KW - vaccination

UR - http://www.scopus.com/inward/record.url?scp=85060988402&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85060988402&partnerID=8YFLogxK

U2 - 10.1111/petr.13354

DO - 10.1111/petr.13354

M3 - Article

VL - 23

JO - Pediatric Transplantation

JF - Pediatric Transplantation

SN - 1397-3142

IS - 2

M1 - e13354

ER -