Varicella‐Zoster Immunization in Pediatric Liver Transplant Recipients: Safe and Immunogenic

• Published in: American journal of transplantation Vol. 12; no. 11; pp. 2974 - 2985
• Main Authors: Posfay‐Barbe, K. M., Pittet, L. F., Sottas, C., Grillet, S., Wildhaber, B. E., Rodriguez, M., Kaiser, L., Belli, D. C., McLin, V. A., Siegrist, C. A.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.11.2012; Elsevier Limited
• Subjects: Age; Antibodies; Antibodies, Viral - immunology; CD4 antigen; Chicken pox; Chickenpox - immunology; Chickenpox - prevention & control; Chickenpox Vaccine - administration & dosage; Child; Child, Preschool; Children; enzyme‐linked immunosorbent assay; Female; Follow-Up Studies; Graft Rejection - prevention & control; Graft Survival; Herpes Zoster - immunology; Herpes Zoster - prevention & control; Herpes Zoster Vaccine - administration & dosage; Humans; humoral; immunity; Immunity (cell-mediated); Immunization; Immunization - methods; Immunocompromised Host - immunology; Immunogenicity; immunosuppression; Infant; Liver transplantation; Liver Transplantation - adverse effects; Liver Transplantation - methods; Lymphocytes B; Lymphocytes T; Male; Pediatrics; Retrospective Studies; Risk Assessment; Safety Management; Serology; Transplantation Immunology; Transplants & implants; Treatment Outcome; T‐lymphocytes; vaccination; Vaccines; Varicella; Varicella zoster virus
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2012.04273.x

Varicella can have a severe course in immunosuppressed patients. Although prevention is fundamental, live‐attenuated varicella‐zoster (VZV) vaccine is not currently recommended in transplant recipients. Our aims were to (1) evaluate VZV immunity in pediatric liver transplant (LT) recipients; (2) immunize (two doses) seronegative patients post‐LT; (3) monitor vaccine safety, (4) assess B and T cell vaccine responses. All patients followed at the Swiss National Pediatric LT Center were approached and 77/79 (97.5%) were enrolled (median age 7.8 years). Vaccine safety was monitored by standardized diary cards and phone calls. VZV‐specific serology and CD4+ T cells were assessed before and after immunization. Thirty‐nine patients (51.1%) were seronegative including 14 children immunized pre‐LT. Thirty‐six of 39 seronegative patients were immunized post‐LT (median 3.0 years post LT). Local (54.8%) and systemic (64.5%) reactions were mild and transient. The frequency of VZV‐specific CD4+ T cells and antibody titers increased significantly (respectively from 0.085% to 0.16%, p = 0.04 and 21.0 to 1134.5 IU/L, p < 0.001). All children reached seroprotective titers and 31/32 (97%) patients assessed remained seroprotected at follow‐up (median 1.7 years). No breakthrough disease was reported during follow‐up (median 4.1 years). Thereby, VZV vaccine appears to be safe, immunogenic and provide protection against disease in pediatric LT patients. Live attenuated varicella vaccine given one year after liver transplantation to 36 pediatric patients is safe and effective, eliciting both humoral and cellular immunity. See editorial by Madan and Herold on page 2871.