Combo Flu Shot Safe in Pediatric Kidney Transplant Patients

SEATTLE—Influenza A/H1N1 vaccination appears to be immunogenic, safe, and tolerable in pediatric kidney transplant and dialysis patients, according to a new study presented at the 33rd Annual Dialysis Conference.

“The novel influenza/H1N1 combination vaccine is considered safe and recommended for the general population,” said study investigator Vaishali Bansilal, MD, a pediatric nephrology fellow at the State University of New York Downstate Medical Center in Brooklyn, N.Y. “There have been some anecdotal reports in literature of acute allograft rejections, mostly in adult population post vaccines, but no concrete evidence for the same in pediatric patients has been published.” 

The vaccine does not seem to stimulate significant de novo anti-HLA antibody production, potentially causing allograft rejection, Dr. Bansilal said.

Emergence of an H1N1 pandemic in April 2009 affected a higher proportion of children with chronic diseases and immunosuppression. It was recommended that renal transplant and chronic kidney disease patients receive the ASO3 adjuvant H1N1 vaccine with influenza A. However, researchers have always been concerned about the potential induction of anti-HLA antibodies as a result of vaccination in adult or pediatric renal transplant recipients.

Dr. Bansilal and colleagues investigated the immunogenicity of influenza A/H1N1 given to 21 pediatric patients on dialysis or a history of a kidney transplant. They also investigated whether there is an increase in anti-HLA antibodies secondary to vaccination. The patients had a mean age of 15.5 years (29% female and 71% male). Among these 21 patients, 71% were male, 57% were African American and 29% were Hispanic. 

The researchers divided the patients into two groups. Group 1 included 12 patients on dialysis, of whom four had a history of kidney transplantation. Group 2 included nine kidney transplant recipients with good graft function. All patients were tested for anti-HLA antibody one month prior to vaccination. The patients were again tested for anti-HLA antibody at one and six months after administration of vaccine.

In group 2, no patient tested positive for either anti-HLA class I or class II before or after vaccination. In group 1, four patients with a previous history of graft failure were mildly sensitized before immunization and two patients showed no change in class I and II. One patient had a mild increase in class I after vaccination and one had an increase in class I by 24%.  The study also showed that none of the patients in group 2 had either cell mediated or humoral rejection secondary to the vaccine. In addition, no patient in group 1 had evidence of anti–HLA antibody following vaccination.

“I was not surprised by the findings in our study since they mimicked the study results in the adult population,” Dr. Bansilal told Renal & Urology News. “There was no significant de novo anti-HLA antibody production post the influenza/H1N1 vaccine, which could potentially cause graft rejection, pertinent to our pediatric population.”

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