Impact of Adjuvanted H1N1 Vaccine on Cell‐Mediated Rejection in Heart Transplant Recipients

• Published in: American journal of transplantation Vol. 11; no. 12; pp. 2751 - 2754
• Main Authors: Schaffer, S. A., Husain, S., Delgado, D. H., Kavanaugh, L., Ross, H. J.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.12.2011; Elsevier Limited
• Subjects: Adjuvant; Adjuvants; Antibodies, Viral - immunology; Antigens; Antigens, Viral - immunology; Biopsy; Canada; Case-Control Studies; cellular rejection; Female; Follow-Up Studies; Graft rejection; Graft Rejection - epidemiology; Graft Rejection - etiology; Graft Rejection - mortality; heart transplant; Heart transplantation; Heart Transplantation - adverse effects; Heart Transplantation - mortality; Heart transplants; Humans; Immunization; Influenza; Influenza A Virus, H1N1 Subtype - immunology; Influenza Vaccines - adverse effects; Influenza virus; Influenza, Human - epidemiology; Influenza, Human - etiology; Male; Middle Aged; Multivariate analysis; Pandemics; Prognosis; Retrospective Studies; Risk Factors; Risk groups; Survival Rate; Swine flu; Vaccination; Vaccines; Virus Replication; Canada
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2011.03743.x

During the H1N1 influenza virus pandemic, vaccination of high risk groups including solid‐organ transplant recipients was advised. A retrospective case control study of 60 heart transplant patients, 15 having received the H1N1 virus antigen and ASO3 adjuvant vaccine (GlaxoSmithKline, Mississauga, ON, Canada) within 21 days and 45 having not been vaccinated, all undergoing routine surveillance endmyocardial biopsies, was performed. The overall rate of cellular rejection (all grades) was not statistically different between groups; however, acute cellular rejection, ≥grade 2 (1990 ISHLT criteria), was more frequent among those having recently vaccinated (control: 1/45 vs. 6/15, p = 0.001). On multivariate analysis, the only risk factor found to be associated with acute cellular rejection was recent H1N1 viral antigen and adjuvant vaccination (OR 26.5: 95% CI 02.59–270.5). Vaccine adjuvants increase host response to vaccine antigens by immune upregulation potentially increasing risk of rejection in solid‐organ transplant recipients. The potential hazard of vaccination this study raises must be weighed with the clear benefit vaccination has proven to be. In heart transplant recipients, administration of the H1N1 vaccine is associated with increased incidence of moderate to severe cellular rejection.