Effect of annual influenza immunization on antibody response in lung transplant patients

Abstract

Background: Influenza viral infections cause significant morbidity and mortality each season. Lung transplant patients may be at higher risk because of their underlying pathophysiology. Although annual immunization is the standard of care, its efficacy remains largely unproven. Previous studies showed poor antibody response to influenza vaccine in lung transplant patients, but no data on the antibody response in consecutive seasons have been published.

Methods: We studied antibody responses to influenza vaccine in 122 subjects: 66 lung transplant recipients, 28 control subjects, and 28 patients awaiting lung transplantation. We compared antibody response rates to individual viruses contained in influenza vaccines in consecutive years within the 3 groups. Serum antibody concentrations were measured at baseline and 2 to 4 weeks after vaccination by using the hemagglutination inhibition assay. Log-transformed antibody concentrations and incidence of serconversion and seroprotection were calculated.

Results: Median log-transformed antibody responses were similar in consecutive seasons in lung transplant subjects. Incidences of seroprotection and seroconversion did not differ between consecutive seasons in lung transplant recipients.

Conclusions: Antibody responses were similar in consecutively measured years in lung transplant subjects. Annual influenza vaccination in lung transplant subjects produces similar immune responses in 2 consecutive years, indicating that these patients are not at significantly increased risk of vaccine failure.

Figures

Figure 1

Log-transformed change in antibody responses for control subjects (A), subjects awaiting lung transplantation (B), and lung transplant recipients (C). The change in antibody concentration from before to after immunization are shown for each antigen in the 2004-2005 and 2005-2006 vaccine seasons. Median antibody response to BShanghai was lower in the second consecutive year for both healthy persons (median log change in antibody response, 0.6; interquartile range [IQR], 0.3-0.9 in 2004 and median, 0.3; IQR, 0-0.3 in 2005) and patients awaiting lung transplantation (median log change in antibody response, 0.6; IQR, 0-1.2 in 2004 and median, 0; IQR, 0-0.3 in 2005) (P < .03 for both).

Figure 1

Log-transformed change in antibody responses for control subjects (A), subjects awaiting lung transplantation (B), and lung transplant recipients (C). The change in antibody concentration from before to after immunization are shown for each antigen in the 2004-2005 and 2005-2006 vaccine seasons. Median antibody response to BShanghai was lower in the second consecutive year for both healthy persons (median log change in antibody response, 0.6; interquartile range [IQR], 0.3-0.9 in 2004 and median, 0.3; IQR, 0-0.3 in 2005) and patients awaiting lung transplantation (median log change in antibody response, 0.6; IQR, 0-1.2 in 2004 and median, 0; IQR, 0-0.3 in 2005) (P < .03 for both).

Figure 2

Incidence of seroconversion in patients taking cyclosporine or tacrolimus immunosuppression.