Vaccination before and after kidney transplantation

Prevention of systemic infections by effective vaccination constitutes an essential issue in pediatrics and is of vital importance especially in the field of organ transplantation. To avoid allograft rejection, transplant recipients usually require life-long immunosuppressive medication, which often leads to a reduced immunogenicity of inactivated vaccines, whereas attenuated live virus vaccines bear the risk of disseminated infections and are therefore contraindicated after transplantation. For these reasons, the vaccination status particularly of pediatric and adolescent patients and, if necessary, also of adults on the waiting list, should be completed before transplantation. Apart from the routine vaccination recommendations issued by the German Standing Committee on Vaccination (STIKO) of the Robert Koch Institute, additional vaccinations according to the guidelines published by the American Society of Transplantation (AST) and the Kidney Disease: Improving Global Outcomes (KDIGO) transplantation work group are necessary. These include hepatitis A and the annual vaccination against influenza. After transplantation, attenuated live virus vaccines, for example, against measles, mumps, rubella, varicella, rotavirus, yellow fever, influenza (intranasal vaccine) and poliovirus (oral vaccine) are contraindicated. A live attenuated vaccination after transplantation should be considered only in cases of exposure and after a careful risk-benefit assessment and remain an exception to the rule. Vaccination titers should be regularly measured after transplantation and, in addition, booster vaccinations with inactivated vaccines are recommended. Furthermore, healthcare workers and close contacts, such as family members of transplant patients should be fully immunized to ensure protection of pediatric kidney allograft recipients through so-called herd immunity. © 2015, Springer-Verlag Berlin Heidelberg.