Vaccination is the most efficient and cost effective intervention to prevent infectious complications in transplantation medicine.

Infectious diseases after solid organ transplantation (SOT) are one of the major complications in transplantation medicine. One of the most important public health interventions to decrease the mortality associated with infections is vaccination. After SOT, the patients are more susceptible to infectious diseases, the present infections more often and with more severe manifestations of them. The response to vaccines with subsequent protection against infectious diseases depends on the function of the immune system.

In terms to when to vaccinate, before SOT the patients have end organ dysfunction and after SOT they have immunosuppression, both have the risk of altering the immune responses to vaccines. It has been documented a variety of seroprotection rates after vaccination in SOT patients, it depends on the type of vaccine, the immunosuppression and the time after transplantation, overall postransplant patients have a worse vaccine response compared to healthy individuals. We should try to vaccinate before SOT, and because it has been documented that antibodies can wane over time or even become undetectable after SOT, for some vaccines you could check serology.

Below are relevant vaccination resources and articles. I am very interested in hearing what you would like to see in an update which can help you in your practice.

Please submit feedback on how vaccination applies TO your practice

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Recent SOT Relevant UPDATES/News

Merck’s Letermovir, an Investigational Antiviral Medicine for Prevention of Cytomegalovirus (CMV) Infection in Bone Marrow Transplant Recipients, Highly Effective Through Week 24 Post-Transplant in Pivotal Phase 3 Study
May hold promise in SOT.

Travel vaccination recommendations and endemic infection risks in solid organ transplantation recipients.
Trubiano JA, Johnson D, Sohail A, Torresi J. - J Travel Med. 2016 Sep 13;23(6)
A very good review on travel vaccination in SOT

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Vaccination News

Oral delivery system could make vaccinations needle-free
Patients could one day self-administer vaccines using a needleless, pill-sized technology that jet-releases a stream of vaccine inside the mouth, according to a proof-of-concept study conducted at UC Berkeley.
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Two-part Ebola vaccine shows potential for long-lasting protection
The two-part shot induced a durable immune response lasting a full year in 100 per cent of healthy volunteers vaccinated, researchers reported.
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Public health: This message must be herd
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On the benefits of explaining herd immunity in vaccine advocacy
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Relevant article in Transplantation
provided by Dr Karen Keung, Editorial Fellow, Transplantation

Long-term follow-up of humoral immune status in adult lung transplant recipients
van Kessel DA, Hoffman TW, Kwakkel-van Erp JM, et al. [published online February 14, 2017]. Transplantation. doi: 10.1097/TP.0000000000001685
The authors show long-term immunologic follow up data of 55 lung transplant recipients (median follow up after transplantation 6.6 years), including antibody responses to pneumococcal vaccination. Their findings demonstrate that humoral immunity remained suppressed over the follow up period, but was most prominent in the first year after lung transplantation. Response to pneumococcal vaccination pre- and post- transplant was also significantly different.
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Vaccination Literature (patients)

For Patients Which Vaccinations Do I Need? (National Kidney Foundation)
This is a useful guide for patients that answer some of the most common questions related to vaccination. Is oriented to adults with kidney disease, kidney failure and kidney transplant.
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Vaccination Literature (professionals)

Updated International Consensus Guidelines on the Management of Cytomegalovirus in Solid-Organ Transplantation
Kotton, Camille Kumar, Deepali; Caliendo, Angela M3; Åsberg, Anders; Chou, Sunwen; Danziger-Isakov, Lara; Humar, Atul; on behalf of The Transplantation Society
International CMV Consensus Groupety developed consensus guidelines on CMV management published in 2013, briefly discusses that there are several CMV vaccines that have clinical endpoints but are currently in early stages of clinical development. Transplantation. 2013 Aug 27;96(4):333-60. doi: 10.1097/TP.0b013e31829df29d
These consensus guidelines on CMV management published in 2013, briefly discusses that there are several CMV vaccines that have clinical endpoints but are currently in early stages of clinical development.
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The Immunogenicity of Influenza Virus Vaccine in Solid Organ Transplant Recipients
Emily A. Blumberg, Caroline Albano, Timothy Pruett, Ross Isaacs, Jane Fitzpatrick, James Bergin, Carolyn Crump, Frederick G. Hayden. Clin Infect Dis 1996; 22 (2): 295-302. doi: 10.1093/clinids/22.2.295
This article evaluated the seroresponse rate in 68 solid organ transplant recipients after influenza vaccination; this study showed that compared to healthy individuals, SOT patients had lower antibody titers post-vaccination (70% SOTs vs 50% healthy subjects), the magnitude of the rise of antibodies was lower (SOTs 1.5-2.3 fold vs. healthy subjects 8.7-10.4 fold) and there was no benefit after giving a second dose of influenza vaccine.
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Vaccination of Solid Organ Transplant Candidates and Recipients
Logan McCool and Steven D. Burdette
This article discusses the different timing for immunization and also gives a brief and useful description of each vaccine recommended in SOT including the indications and side effects.
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Vaccination in Solid Organ Transplantation
Danziger-Isakov, L., Kumar, D. and the AST Infectious Diseases Community of Practice (2013), Vaccination in Solid Organ Transplantation .AJT, 13: 311–317. doi:10.1111/ajt.12122
This article is very useful because it includes pediatric recommendations of vaccination, it discusses the vaccines that health care workers and close contacts of SOT patients should have and also for transplant recipients who intent to travel they review the travel vaccine recommendations.
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Guidelines for Vaccination of Solid Organ Transplant Candidates and Recipients
Danzinger-Isakov, L., Kumar, D. and the AST Infectious Diseases Community of Practice (2009), Guidelines for Vaccination of Solid Organ Transplant Candidates and Recipients. AJT, 9: S258–S262. doi:10.1111/j.1600-6143.2009.02917.x
This important article in 2009 summarized the most recent recommendations in vaccination in SOT with useful tables for quick search.
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Immunization for Adult Solid Organ Transplant Candidates and Recipients
This is the Province of Alberta (Canada) immunization policy in solid organ candidates and recipients; all recommendations are summarized in a precise table that includes the periodicity of vaccination and special comments of each vaccine.
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Infection in Solid-Organ Transplant Recipients
Jay A. Fishman, M.D. N Engl J Med 2007; 357:2601-2614 / December 20, 2007 / DOI: 10.1056/NEJMra064928
This is a classical article in transplant infectious diseases from New England Journal of Medicine, and it briefly discusses general strategies to prevent infections including vaccination.
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About our guest editor

Armelle Pérez-Cortés Villalobos MD, MSc

She received her medical degree in 2009 at Panamerican University in Mexico City. After which she specialized in internal medicine and did a fellowship in infectious diseases at the National Institute of Medical Sciences and Nutrition "Salvador Zubirán" in Mexico City (2009 – 2015). In 2012 she did an observership in transplant infectious diseases at the Toronto General Hospital. In 2015, after finishing her ID fellowship, she started a Masters in Medical Sciences which she recently concluded in January 2017. Currently she is working on a research protocol to evaluate the immune response of solid organ transplant recipients to the Bordetella pertussis vaccine.

Upcoming TTS Endorsed Meeting

2017 Banff-SCT Joint Scientific Meeting
co-hosted by Societat Catalana deTrasplantament and BANFF Foundation of Allograft Pathology
March 27-31 - In less than 2 weeks!
Barcelona, Spain
www.sctransplant.org/sct2017/

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Upcoming Meeting Deadlines

March 17 - Early Bird Registration Deadline
Transplantation Science Symposium (www.tss2017.org)
May 24-26 - Victoria, BC, Canada

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March 24, 2017 - Early Bird Registration Deadline
Intestinal Rehabilitation and Transplant Association (www.cirta2017.org)
June 28 - July 1 - New York, NY, USA

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April 5, 2017 - Early Bird Registration Deadline
International Pancreas & Islet Transplant Association (www.ipita2017.org)
June 20-23 - Oxford, United Kingdom

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April 7, 2017 - Abstract Submission Deadline
International Xenotransplantation Association (www.ixa2017.org)
September 20-23 - Baltimore, MD, USA

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Webinar for YOUR Fellows and Students

OPEN TO MEMBERS AND NON-MEMBERS.
FORWARD THIS EMAIL TO YOUR FELLOWS!

THURSDAY, April 6, 2017, 11AM (MONTREAL TIME) TRANSPLANTATION AND PRIVATE PRACTICE: A CAREER ALTERNATIVE AND ITS IMPACT ON ACADEMIC RECRUITMENT Daniel C. Brennan Professor of Renal Diseases Director of Transplant Nephrology Washington University School of Medicine St. Louis, Missouri, United States CLICK HERE TO SIGNUP

IN THE NEWS

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How 3D Printing Could Revolutionise Organ Transplantation
Mar. 3 - technologynetworks.com - In the past decade, engineers at the University of California San Diego have 3D printed a variety of devices ranging from rocket engines, to robots, to structures inspired by the seahorse’s tail. Now, nanoengineers have added a new item to that list: a 3D printed biomimetic blood vessel network.
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Japan kicking regenerative medicine development into high gear
Mar. 10 - Asian Review - Three academic and business groups in Japan are planning to conduct clinical studies on donated stem cells in the fiscal year starting next month, aiming to commercialize such regenerative therapy.
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Nepal - Free of cost kidney transplant service from mid April
Mar 9 - Kathmandu - The government is preparing to provide free kidney transplant services to the kidney patients from the state-run health facilities applicable from the beginning of the Nepali New Year. http://bit.ly/2n3dijp
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Should Belatacept Be the Centrepiece of Renal Transplantation?
Mar. 10 - Medscape - Belatacept was developed to minimize cardiovascular risk and nephrotoxicity associated with calcineurin inhibitor (CNI)–based immunosuppression. Recently, 7-year data from the Belatacept Evaluation of Nephroprotection and Efficacy as First-line Immunosuppression Trial (BENEFIT), a phase III study comparing belatacept with cyclosporine, have been published. While during the first year of belatacept the risk of acute rejection episodes was elevated, this seemingly had marginal consequences for long-term graft survival and function as well as patient survival.
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For organ transplant recipients, skin diseases and risk factors differ by race
Mar. 8 - Medical Express - It's been long recognized that the immunosuppressant drugs patients are prescribed after an organ transplant come with a fair share of dangerous side effects—including squamous cell carcinoma and other types of skin disease. But despite advances to improve skin cancer prevention for these patients, little is known about how skin conditions affect African-American, Asian and Hispanic transplant recipients. That's a problem, considering that more than half of the 120,000 Americans on the waiting list for organs are nonwhite, according to the U.S. Department of Health and Human Services.
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China - Proposal on organ donation discussed at two sessions
Mar. 8 - Global Times - China is closer to legislation on human organ transplants to regulate the donation and procurement process amid surging demand for human organs, said one of the country's top political advisors, while refuting rumors that China harvests organs from living people.
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India - Cadaveric organ donation in casualty
Mar. 10 - The New Indian Express - Even as Odisha takes pride in performing highest renal transplants in a Government set up in eastern India, slow progress in facilitating cadaveric organ donation and lack of facilities to test harvested organs have left the health experts worried.
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Recurrent Autoimmune Liver Diseases After Liver Transplantation
Mar. 10 - Medscape - Autoimmune liver diseases (AILD) constitute the third most common indication for liver transplantation (LT) worldwide. Outcomes post LT are generally good but recurrent disease is frequently observed.
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People with autism, intellectual disabilities fight bias in transplants
Mar. 3 - The Washington Post - Paul Corby needs a new heart. On that there is no dispute. The same rare disease that killed his father at 27 is destroying his left ventricle. While there is no cure or surgery that might repair the damage, a heart transplant could extend his life considerably. But Corby, who lives in Pottsville, Pa., is autistic, suffers from several psychological conditions and takes 19 medications. When he applied to the transplant program at the University of Pennsylvania in 2011, he was rejected because of his “psychiatric issues, autism, the complexity of the process . . . and the unknown and unpredictable effect of steroids on behavior,” according to the denial letter sent to his mother.
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Acute Myocardial Infarction Common in Renal Transplant Recipients
Mar. 3 - Infectious Disease Advisor - Renal transplant recipients (RTRs) are often admitted with acute myocardial infarction (AMI), according to a study published in The American Journal of Cardiology. Sahil Agrawal, MD, from St. Luke's University Health Network in Bethlehem, Pennsylvania, and colleagues examined recent trends in AMI admissions for 9243 RTRs with functioning grafts. Data were compared to those of 160,932 patients with end-stage renal disease without transplantation (ESRD-NRT) and 5,640,851 patients without advanced kidney disease (non-ESRD/RT) admitted with AMI.
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Research provides insights on antibody-mediated rejection in kidney transplant patients
Mar. 3 - News-Medical.net - New research provides insights on transplant recipients' antibody responses against donor kidneys and how the timing of those responses can have important implications. The findings appear in an upcoming issue of the Journal of the American Society of Nephrology (JASN).
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