Vaccination in Solid Organ Transplantation

Transplant candidates and recipients are at increased risk of infectious complications of vaccine-preventable diseases. Every effort should be made to ensure that transplant candidates, their household members and healthcare workers have completed the full complement of recommended vaccinations prior to transplantation. Since the response to many vaccines is diminished in organ failure, transplant candidates should be immunized early in the course of their disease. It is recommended that vaccination status ideally be documented at the pretransplant clinic visit and the patient referred for the appropriate vaccines at the time of listing. Many transplant centers will do routine pretransplant serology for vaccine-preventable diseases such as Hepatitis B, Varicella, measles, mumps and rubella to guide individual vaccine recommendations (Tables 1 and 2).Table 1:Recommendations for immunization of pediatric patientsInactivated/ liveRecommendedRecommendedMonitor vaccineQualityVaccineattentuated (I/LA)before transplant1Whenever possible, the complete complement of vaccines should be administered before transplantation. Vaccines noted to be safe for administration after transplantation may not be sufficiently immunogenic after transplantation.after transplanttitersevidenceInfluenza (17Mack DR Chartrand SA Ruby EI Antonson DL Shaw Jr., BW Heffron TG Influenza vaccination following liver transplantation in children.Liver Transpl Surg. 1996; 2: 431-437Google Scholar, 18Madan RP Tan M Fernandez-Sesma A et al.A prospective, comparative study of the immune response to inactivated influenza vaccine in pediatric liver transplant recipients and their healthy siblings.Clin Infect Dis. 2008; 46: 712-718Google Scholar, 19Duchini A Hendry RM Nyberg LM Viernes ME Pockros PJ Immune response to influenza vaccine in adult liver transplant recipients.Liver Transpl. 2001; 7: 311-313Google Scholar, 20Scharpe J Evenepoel P Maes B et al.Influenza vaccination is efficacious and safe in renal transplant recipients.Am J Transplant. 2008; 8: 332-337Google Scholar, 21Manuel O Humar A Chen MH et al.Immunogenicity and safety of an intradermal boosting strategy for vaccination against influenza in lung transplant recipients.Am J Transplant. 2007; 7: 2567-2572Google Scholar)IYesYesNoII-1LASee textNoNoIIIHepatitis B2Routine vaccine schedule recommended prior to transplant and as early in the course of disease as possible; vaccine poorly immunogenic after transplantation, and accelerated schedules may be less immunogenic. Serial hepatitis B surface antibody titers should be assessed both before and every 6–12 months after transplantation to assess ongoing immunity (28).(22Arslan M Wiesner RH Sievers C Egan K Zein NN Double-dose accelerated hepatitis B vaccine in patients with end-stage liver disease.Liver Transpl. 2001; 7: 314-320Google Scholar, 23Horlander JC Boyle N Manam R et al.Vaccination against hepatitis B in patients with chronic liver disease awaiting liver transplantation.Am J Med Sci. 1999; 318: 304-307Google Scholar, 24Loinaz C de Juanes JR Gonzalez EM et al.Hepatitis B vaccination results in 140 liver transplant recipients.Hepatogastroenterology. 1997; 44: 235-238Google Scholar, 25Duca P Del Pont JM D’Agostino D Successful immune response to a recombinant hepatitis B vaccine in children after liver transplantation.J Pediatr Gastroenterol Nutr. 2001; 32: 168-170Google Scholar, 26Carey W Pimentel R Westveer MK Vogt D Broughan T Failure of hepatitis B immunization in liver transplant recipients: results of a prospective trial.Am J Gastroenterol. 1990; 85: 1590-1592Google Scholar, 27Foster WQ Murphy A Vega DJ Smith AL Hott BJ Book WM Hepatitis B vaccination in heart transplant candidates.J Heart Lung Transplant. 2006; 25: 106-109Google Scholar, 28Are booster immunisations needed for lifelong hepatitis B immunity? European Consensus Group on Hepatitis B Immunity.Lancet. 2000; 355: 561-565Google Scholar)IYesYesYesII-1Hepatitis A3For children, routine recommendation for all transplant candidates and recipients. In adults, routinely recommended for liver transplant candidates and recipients. Other adults pre-or posttransplant should receive if high risk of exposure (e.g. travel or residence in high-risk areas, occupational or lifestyle risk of exposure). Monitoring indicated only if ongoing risk for exposure, for example with planned travel to high-risk areas. (29Stark K Gunther M Neuhaus R et al.Immunogenicity and safety of hepatitis A vaccine in liver and renal transplant recipients.J Infect Dis. 1999; 180: 2014-2017Google Scholar,30Gunther M Stark K Neuhaus R Reinke P Schroder K Bienzle U Rapid decline of antibodies after hepatitis A immunization in liver and renal transplant recipients.Transplantation. 2001; 71: 477-479Google Scholar)IYesYesYes (see footnote)II-1PertussisIYesYesNoIIIDiphtheria (31Balloni A Assael BM Ghio L et al.Immunity to poliomyelitis, diphtheria and tetanus in pediatric patients before and after renal or liver 1999; Scholar, to and rubella in on A of the 1997; Scholar, C Ghio L A et of immunity to diphtheria and tetanus in transplant Transplant. 1999; Scholar, A P J to diphtheria and tetanus booster vaccination in pediatric renal transplant recipients.Transplantation. 1997; (31Balloni A Assael BM Ghio L et al.Immunity to poliomyelitis, diphtheria and tetanus in pediatric patients before and after renal or liver 1999; Scholar, to and rubella in on A of the 1997; Scholar, C Ghio L A et of immunity to diphtheria and tetanus in transplant Transplant. 1999; Scholar, A P J to diphtheria and tetanus booster vaccination in pediatric renal transplant recipients.Transplantation. 1997; vaccine (31Balloni A Assael BM Ghio L et al.Immunity to poliomyelitis, diphtheria and tetanus in pediatric patients before and after renal or liver 1999; recommended if B is in the A et response to B vaccination in renal transplant recipients with 1999; recommended if for M on in organ transplant recipients: to J Transplant. 2008; 8: D C D Humar A of vaccination in renal transplant recipients.J Infect Dis. Scholar, D Chen MH et al.A to the strategy for vaccination in adult liver transplant Infect Dis. 2008; Scholar, D B D Chen MH Humar A of vaccine in renal transplant of a trial.Am J Transplant. 2007; 7: C T et of influenza vaccine in organ transplant Infect Dis. 1996; M et and of the of and vaccine schedule in pediatric organ transplant recommended if for M on in organ transplant recipients: to J Transplant. 2008; 8: D C D Humar A of vaccination in renal transplant recipients.J Infect Dis. Scholar, D Chen MH et al.A to the strategy for vaccination in adult liver transplant Infect Dis. 2008; Scholar, D B D Chen MH Humar A of vaccine in renal transplant of a trial.Am J Transplant. 2007; 7: C T et of influenza vaccine in organ transplant Infect Dis. 1996; M et and of the of and vaccine schedule in pediatric organ transplant patients of and adults or patients as as months of the following members of the to high risk areas, complement complement such as prior to with or on are in posttransplant and children, vaccination recommendations may and recommendations for M on in organ transplant recipients: to J Transplant. 2008; 8: the on not to routine vaccination of all children with vaccine 2008; routinely for or to (see vaccine should be administered after months of and the vaccine may be as early as months not routinely recommended after vaccines and have administered to organ transplant recipients on is at the of the individual transplant with the of the for vaccination in In adults, are of disease with vaccination vaccination is in pediatric renal Transplant. 2001; Scholar, M M A et to immunization in pediatric liver transplant recipients.Transplantation. 2000; Scholar, J immunization after liver Transplant. 2006; Scholar, A et and of vaccine in pediatric liver and transplant recipients.Am J Transplant. 2006; vaccine should be administered after months of and the vaccine may be as early as months not routinely recommended after vaccines and have administered to organ transplant recipients on is at the of the individual transplant with the of the for vaccination in In adults, are of disease with vaccination K to early vaccination in with chronic renal 1999; Scholar, A D et in children with renal J Transplant. 2006; Scholar, vaccination after liver transplantation.J Scholar, M K T T and safe with vaccines for children after liver 2008; vaccine should be administered after months of and the vaccine may be as early as months not routinely recommended after vaccines and have administered to organ transplant recipients on is at the of the individual transplant with the of the for vaccination in In adults, are of disease with vaccination K to early vaccination in with chronic renal 1999; M K T T and safe with vaccines for children after liver 2008; vaccine should be administered after months of and the vaccine may be as early as months not routinely recommended after vaccines and have administered to organ transplant recipients on is at the of the individual transplant with the of the for vaccination in In adults, are of disease with vaccination to and rubella in on A of the 1997; K to early vaccination in with chronic renal 1999; M K T T and safe with vaccines for children after liver 2008; for administration in the are to in exposure to is and to have or are not recipients are of a patient with should be immune may be administered if have less should not be RH vaccination and the patient with an organ Infect Dis. possible, the complete complement of vaccines should be administered before transplantation. Vaccines noted to be safe for administration after transplantation may not be sufficiently immunogenic after vaccine schedule recommended prior to transplant and as early in the course of disease as possible; vaccine poorly immunogenic after transplantation, and accelerated schedules may be less immunogenic. Serial hepatitis B surface antibody titers should be assessed both before and every 6–12 months after transplantation to assess ongoing immunity booster immunisations needed for lifelong hepatitis B immunity? European Consensus Group on Hepatitis B Immunity.Lancet. 2000; 355: 561-565Google children, routine recommendation for all transplant candidates and recipients. In adults, routinely recommended for liver transplant candidates and recipients. Other adults pre-or posttransplant should receive if high risk of exposure (e.g. travel or residence in high-risk areas, occupational or lifestyle risk of exposure). Monitoring indicated only if ongoing risk for exposure, for example with planned travel to high-risk recommended if B is in the recommended if for patients of and adults or patients as as months of the following members of the to high risk areas, complement complement such as prior to with or on are in posttransplant and children, vaccination recommendations may and recommendations for routinely for or to vaccine should be administered after months of and the vaccine may be as early as months not routinely recommended after vaccines and have administered to organ transplant recipients on and safety of measles, rubella and vaccines in transplant recipients J 2008; is at the of the individual transplant with the of the for vaccination in In adults, are of disease with vaccination Shaw JC vaccine in a heart transplant 2006; for administration in the are to in exposure to is and to have or are not Transplant recipients are of a patient with should be immune may be administered if have less should not be in a for immunization of adult patientsInactivated/ (I/LA)before transplant1Whenever possible, the complete complement of vaccines should be administered before transplantation. Vaccines noted to be safe for administration after transplantation may not be sufficiently immunogenic after transplantation.after (17Mack DR Chartrand SA Ruby EI Antonson DL Shaw Jr., BW Heffron TG Influenza vaccination following liver transplantation in children.Liver Transpl Surg. 1996; 2: 431-437Google Scholar, 18Madan RP Tan M Fernandez-Sesma A et al.A prospective, comparative study of the immune response to inactivated influenza vaccine in pediatric liver transplant recipients and their healthy siblings.Clin Infect Dis. 2008; 46: 712-718Google Scholar, 19Duchini A Hendry RM Nyberg LM Viernes ME Pockros PJ Immune response to influenza vaccine in adult liver transplant recipients.Liver Transpl. 2001; 7: 311-313Google Scholar, 20Scharpe J Evenepoel P Maes B et al.Influenza vaccination is efficacious and safe in renal transplant recipients.Am J Transplant. 2008; 8: 332-337Google Scholar, 21Manuel O Humar A Chen MH et al.Immunogenicity and safety of an intradermal boosting strategy for vaccination against influenza in lung transplant recipients.Am J Transplant. 2007; 7: 2567-2572Google textNoNoIIIHepatitis vaccine schedule recommended prior to transplant and as early in the course of disease as possible; vaccine poorly immunogenic after transplantation, and accelerated schedules may be less immunogenic. Serial hepatitis B surface antibody titers should be assessed both before and every 6–12 months after transplantation to assess ongoing immunity M Wiesner RH Sievers C Egan K Zein NN Double-dose accelerated hepatitis B vaccine in patients with end-stage liver disease.Liver Transpl. 2001; 7: 314-320Google Scholar, 23Horlander JC Boyle N Manam R et al.Vaccination against hepatitis B in patients with chronic liver disease awaiting liver transplantation.Am J Med Sci. 1999; 318: 304-307Google Scholar, 24Loinaz C de Juanes JR Gonzalez EM et al.Hepatitis B vaccination results in 140 liver transplant recipients.Hepatogastroenterology. 1997; 44: 235-238Google Scholar, 25Duca P Del Pont JM D’Agostino D Successful immune response to a recombinant hepatitis B vaccine in children after liver transplantation.J Pediatr Gastroenterol Nutr. 2001; 32: 168-170Google Scholar, 26Carey W Pimentel R Westveer MK Vogt D Broughan T Failure of hepatitis B immunization in liver transplant recipients: results of a prospective trial.Am J Gastroenterol. 1990; 85: 1590-1592Google Scholar, 27Foster WQ Murphy A Vega DJ Smith AL Hott BJ Book WM Hepatitis B vaccination in heart transplant candidates.J Heart Lung Transplant. 2006; 25: 106-109Google Scholar, 28Are booster immunisations needed for lifelong hepatitis B immunity? European Consensus Group on Hepatitis B Immunity.Lancet. 2000; 355: 561-565Google Scholar)IYesYesYes (see children, routine recommendation for all transplant candidates and recipients. In adults, routinely recommended for liver transplant candidates and recipients. Other adults pre-or posttransplant should receive if high risk of exposure (e.g. travel or residence in high-risk areas, occupational or lifestyle risk of exposure). Monitoring indicated only if ongoing risk for exposure, for example with planned travel to high-risk areas. (29Stark K Gunther M Neuhaus R et al.Immunogenicity and safety of hepatitis A vaccine in liver and renal transplant recipients.J Infect Dis. 1999; 180: 2014-2017Google Scholar,30Gunther M Stark K Neuhaus R Reinke P Schroder K Bienzle U Rapid decline of antibodies after hepatitis A immunization in liver and renal transplant recipients.Transplantation. 2001; 71: 477-479Google (31Balloni A Assael BM Ghio L et al.Immunity to poliomyelitis, diphtheria and tetanus in pediatric patients before and after renal or liver 1999; Scholar, to and rubella in on A of the 1997; Scholar, C Ghio L A et of immunity to diphtheria and tetanus in transplant Transplant. 1999; Scholar, A P J to diphtheria and tetanus booster vaccination in pediatric renal transplant recipients.Transplantation. 1997; tetanus booster in the should be of should be in with to of and with in with recommended if for D C D Humar A of vaccination in renal transplant recipients.J Infect Dis. Scholar, D Chen MH et al.A to the strategy for vaccination in adult liver transplant Infect Dis. 2008; Scholar, D B D Chen MH Humar A of vaccine in renal transplant of a trial.Am J Transplant. 2007; 7: C T et of influenza vaccine in organ transplant Infect Dis. 1996; patients of and adults or patients as as months of the following members of the to high risk areas, complement complement such as prior to with or on are in posttransplant and children, vaccination recommendations may and recommendations for routinely for or to (see vaccine should be administered after months of and the vaccine may be as early as months not routinely recommended after vaccines and have administered to organ transplant recipients on is at the of the individual transplant with the of the for vaccination in In adults, are of disease with vaccination for administration in the are to in exposure to is and to have or are not recipients are of a patient with should be immune may be administered if have less should not be RH vaccination and the patient with an organ Infect Dis. possible, the complete complement of vaccines should be administered before transplantation. Vaccines noted to be safe for administration after transplantation may not be sufficiently immunogenic after vaccine schedule recommended prior to transplant and as early in the course of disease as possible; vaccine poorly immunogenic after transplantation, and accelerated schedules may be less immunogenic. Serial hepatitis B surface antibody titers should be assessed both before and every 6–12 months after transplantation to assess ongoing immunity booster immunisations needed for lifelong hepatitis B immunity? European Consensus Group on Hepatitis B Immunity.Lancet. 2000; 355: 561-565Google children, routine recommendation for all transplant candidates and recipients. In adults, routinely recommended for liver transplant candidates and recipients. Other adults pre-or posttransplant should receive if high risk of exposure (e.g. travel or residence in high-risk areas, occupational or lifestyle risk of exposure). Monitoring indicated only if ongoing risk for exposure, for example with planned travel to high-risk tetanus booster in the should be of should be in with to of and with in with recommended if for patients of and adults or patients as as months of the following members of the to high risk areas, complement complement such as prior to with or on are in posttransplant and children, vaccination recommendations may and recommendations for routinely for or to vaccine should be administered after months of and the vaccine may be as early as months not routinely recommended after vaccines and have administered to organ transplant recipients on and safety of measles, rubella and vaccines in transplant recipients J 2008; is at the of the individual transplant with the of the for vaccination in In adults, are of disease with vaccination Shaw JC vaccine in a heart transplant 2006; for administration in the are to in exposure to is and to have or are not Transplant recipients are of a patient with should be immune may be administered if have less should not be in a every effort should be made to prior to transplantation, inactivated vaccines are safe after organ transplantation. inactivated vaccines are for transplant candidates or recommendations made immunization (e.g. the on in the for the should be is to to vaccination is in for influenza in the vaccination on Influenza M on in organ transplant recipients: to J Transplant. 2008; 8: In vaccines are not administered after transplantation. is recommended to vaccines such as measles, rubella vaccine and vaccine prior to transplantation. patients are or prior to with an infectious diseases is possible, should be at the time of pretransplant to for time for vaccine the time to vaccines after transplantation is not centers vaccinations at months after transplantation are to an immune response will be the and of after organ transplantation. It is the response as is with of should be documented for vaccines are and titers are A of should vaccine administration and for on titers in the that serology may not be an of immunity in the posttransplant for immunity is an of that study in workers and such as of transplant recipients should be immunized and in should receive influenza vaccine In if inactivated vaccine are for household members are Influenza vaccination is It is that and receive inactivated influenza if influenza vaccine is the only be with of such as for a after to be after administration RM T of influenza vaccine in children months of the of and vaccines is to risk the members or In is that household and be against measles, rubella and to the patient with vaccines a risk of and be in in of to after the in following should be after should be is or risk of following immunization of with vaccines (e.g. for workers and members of transplant DR Chartrand SA Ruby EI Antonson DL Shaw Jr., BW Heffron TG Influenza vaccination following liver transplantation in children.Liver Transpl Surg. 1996; 2: 431-437Google Scholar, 18Madan RP Tan M Fernandez-Sesma A et al.A prospective, comparative study of the immune response to inactivated influenza vaccine in pediatric liver transplant recipients and their healthy siblings.Clin Infect Dis. 2008; 46: 712-718Google Scholar, 19Duchini A Hendry RM Nyberg LM Viernes ME Pockros PJ Immune response to influenza vaccine in adult liver transplant recipients.Liver Transpl. 2001; 7: 311-313Google Scholar, 20Scharpe J Evenepoel P Maes B et al.Influenza vaccination is efficacious and safe in renal transplant recipients.Am J Transplant. 2008; 8: 332-337Google Scholar, 21Manuel O Humar A Chen MH et al.Immunogenicity and safety of an intradermal boosting strategy for vaccination against influenza in lung transplant recipients.Am J Transplant. 2007; 7: 2567-2572Google (see B M Wiesner RH Sievers C Egan K Zein NN Double-dose accelerated hepatitis B vaccine in patients with end-stage liver disease.Liver Transpl. 2001; 7: 314-320Google Scholar, 23Horlander JC Boyle N Manam R et al.Vaccination against hepatitis B in patients with chronic liver disease awaiting liver transplantation.Am J Med Sci. 1999; 318: 304-307Google Scholar, 24Loinaz C de Juanes JR Gonzalez EM et al.Hepatitis B vaccination results in 140 liver transplant recipients.Hepatogastroenterology. 1997; 44: 235-238Google Scholar, 25Duca P Del Pont JM D’Agostino D Successful immune response to a recombinant hepatitis B vaccine in children after liver transplantation.J Pediatr Gastroenterol Nutr. 2001; 32: 168-170Google Scholar, 26Carey W Pimentel R Westveer MK Vogt D Broughan T Failure of hepatitis B immunization in liver transplant recipients: results of a prospective trial.Am J Gastroenterol. 1990; 85: 1590-1592Google Scholar, 27Foster WQ Murphy A Vega DJ Smith AL Hott BJ Book WM Hepatitis B vaccination in heart transplant candidates.J Heart Lung Transplant. 2006; 25: 106-109Google Scholar, 28Are booster immunisations needed for lifelong hepatitis B immunity? European Consensus Group on Hepatitis B Immunity.Lancet. 2000; 355: 561-565Google A (29Stark K Gunther M Neuhaus R et al.Immunogenicity and safety of hepatitis A vaccine in liver and renal transplant recipients.J Infect Dis. 1999; 180: 2014-2017Google Scholar,30Gunther M Stark K Neuhaus R Reinke P Schroder K Bienzle U Rapid decline of antibodies after hepatitis A immunization in liver and renal transplant recipients.Transplantation. 2001; 71: 477-479Google A et response to B vaccination in renal transplant recipients with 1999; tetanus booster in the should be of should be in with to of and with in with vaccination is in pediatric renal Transplant. 2001; Scholar, M M A et to immunization in pediatric liver transplant recipients.Transplantation. 2000; Scholar, J immunization after liver Transplant. 2006; Scholar, A et and of vaccine in pediatric liver and transplant recipients.Am J Transplant. 2006; K to early vaccination in with chronic renal 1999; Scholar, A D et in children with renal J Transplant. 2006; Scholar, vaccination after liver transplantation.J Scholar, M K T T and safe with vaccines for children after liver 2008; K to early vaccination in with chronic renal 1999; vaccination after liver transplantation.J M K T T and safe with vaccines for children after liver 2008; K to early vaccination in with chronic renal 1999; vaccination after liver transplantation.J M K T T and safe with vaccines for children after liver 2008; tetanus booster in the should be of should be in with to of and with in with in a of to and disease may be a or Since vaccine is possible, serology should be prior to transplant and the transplant In the of antibody with response to is after 1 of antibody be administered as early as months of for pediatric patients may transplantation. transplantation not the time the is a of and transplant is not should be of be administered as as after the children should complete a with at R R on before and after transplantation in the pediatric organ transplant Transplant. adults should receive of with not the be if time such as immune with the response to vaccine should be for months after the of In vaccines (e.g. and be administered on the if not on the the vaccine should be administered Since is of the pretransplant should be noted that vaccines with the be on the as the vaccine if not on the should be to complications in the posttransplant vaccine is a vaccine that is indicated prior to transplant in possible, serology should be prior to transplant and the transplant to antibody with response to vaccine and the vaccine is after 1 of antibody vaccine be administered as early as months of for pediatric patients transplantation. should be adults should receive of vaccine with not the be if time do not are candidates for should after transplantation. with the of vaccine with of and of to should be in the administration of vaccine in pediatric transplant patients in a in pediatric transplant recipients that vaccine is safe and immunogenic after transplantation C et immunization in pediatric liver transplant recipients: and J Transplant. are in In of that at vaccination should be only in a vaccine is a vaccine that is in to and It is indicated for It should not be posttransplant or not the transplant is disease may to immunity against the In the pretransplant centers are to that will the risk of posttransplant or will be in of is an for In for patients that have an of vaccine be after the the vaccine for of on of after the of is are and D L et al.Influenza vaccination in the organ transplant and J Transplant. should for for of all vaccine have in the organ transplant and safety are with the a with intradermal vaccine to in healthy adults Jr., et of the and safety of a influenza vaccine administered intradermal and in healthy vaccines are vaccine and are for (e.g. vaccines in in K R et antibody after and influenza immunization in transplant recipients.Am J Transplant. B N et response to an influenza A vaccine in renal transplant Transplant. are to to of and the vaccines are and should not at to the risk of is not recommended posttransplant D L et al.Influenza vaccination in the organ transplant and J Transplant. vaccine to be safe in and patients study in organ transplant patients JC J et of the vaccine and of influenza A and B, administered to and Infect Dis. 2000; N et of influenza vaccine in to children with a vaccine to be administered to a transplant and with an inactivated influenza vaccine be be to awaiting at should before Since influenza vaccine is recommended of vaccination is of have that vaccine in the months posttransplant is poorly immunogenic is to an increased safety may a transplant to for an influenza In the the recommended that all patients transplant recipients be immunized prior to may to patients immunized early posttransplant and immune response to months after transplant be if the time for of vaccine are vaccine and an vaccine is recommended for in and and vaccine in the vaccine be in to the of vaccine be of of vaccines are and not is or on are for the of vaccines in the posttransplant A vaccine schedule should be prior to transplant in the if all are not completed the be months A study in adult posttransplant patients with vaccine D P et and of vaccine in organ transplant recipients.Am J Transplant. in the transplant are for the is an for are a vaccine and a vaccines may antibodies of and to of B vaccines are and are recommended in routine immunization for pediatric transplant recipients. In adults vaccines a to vaccines D C D Humar A of vaccination in renal transplant recipients.J Infect Dis. In in the vaccine is for a vaccine not of vaccine the in the and titers with both D Chen MH et al.A to the strategy for vaccination in adult liver transplant Infect Dis. 2008; vaccine recommendations for adults are the recommended a strategy vaccine for is and may titers should be as have to decline posttransplant D B D Chen MH Humar A of vaccine in renal transplant of a trial.Am J Transplant. 2007; 7: children should be less of should receive vaccine to of should receive vaccine as of a vaccine and recommendations for on or schedule after schedule of after of or after in a In children are transplant candidates and recipients months should receive at after transplant recipients to travel to of increased risk for immunization status should be routine vaccinations (e.g. Hepatitis and vaccinations such as vaccine should be (see for travel vaccine liveRecommendedRecommendedMonitor vaccineQualityVaccineattentuated (I/LA)before vaccination may be for travel to of and should be if are should be travel to that risk of M for B Chen after of and the 2000; T and of the inactivated vaccine against 2000; ME J 2000; and vaccine inactivated vaccine against and in the T with against and 2008; 7: vaccination may be for travel to of and should be if are should be travel to that risk of M et and of the of and vaccine schedule in pediatric organ transplant inactivated vaccine against and in the in a a and in the of and the of of of have of to as the of and and

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