Pneumococcal and tetanus vaccination in tacrolimus treated kidney transplant recipients with and without mycophenolate mofetil: a randomized controlled trial

A.E. de Weerd, M.J. Verschragen, J.A. van Gestel, W.A. Dik, M.G.H. Betjes

Wednesday 13 march 2019

17:00 - 17:10h at Koningin Máximazaal

Categories: Best abstracts, Parallelsessie

Parallel session: Parallelsessie VI – Best abstracts I

Background: The Gezondheidsraad (Dutch medical council) advices to adopt the anti-pneumococcal vaccine PPV23 for all people of 60 years and older in the Rijksvaccinatieprogramma. Tacrolimus/ mycophenolate mofetil (TAC/MMF) is the current standard for immunosuppression after (kidney) transplantation. The impact of these drugs on pneumococcal vaccination is unknown. We have performed a randomized controlled trial in immunologically low-risk kidney transplant recipients comparing TAC/MMF with TAC monotherapy. This study provides a model to study differential effects of these drugs on vaccination responses.

Methods: Kidney transplant recipients (eGFR >30 ml/min; proteinuria

Results: Only 3 out 57 patients had protective anti-pneumococcal antibodies before vaccination. 42% of combined TAC/MMF treated patient had protective antibodies after vaccination, versus 77% of patients treated with TAC only (p 0.01). Age and renal function had no impact on antibody responses: in multivariate analysis, only the type of the immunosuppressive regimen correlated with protective antibody levels (Expb 1.18; p 0.012). All but two patients had protective baseline antibody titers against tetanus, although none of the patients reported vaccination in 5 years prior. The anti-tetanus titer increased 2.1 times in TAC/MMF versus 10.7 in TACmono treated recipients after vaccination (p <0.0001).

Conclusions: Treatment with TAC/MMF abates antibody responses after pneumococcal and tetanus vaccination. As for the recommended PPV23 vaccination, especially the addition of MMF seriously hampers protective responses. We are currently enrolling an extension study in which patients receive a PPV23 booster vaccine after 5 years.

9 or more titers were >1 ug/mL the vaccination response was defined as protective. None of the recipients had received prior anti-pneumococcal vaccination.