Pneumococcal disease in adult solid organ transplantation recipients

Table 1 Outcome of invasive pneumococcal disease in solid organ transplantation recipients

Ref.	n	Inclusion period	Organ	Time since transplant median (range)	Type of IPD	Prior vaccination	Most frequent isolated serotypes	Graft dysfunction/loss	Mortality
Linnemann et al[14]	12	1971-1977	Kidney	No data	Pneumonia: 83% Bacteremia: 41% Meningitis: 16%	No	8, 9, 12, 24	75%/22.2%	8.30% (1/12)
Amber et al[15]	5	1985-1987	Heart	0.15 yr (1.2-4.4 mo)	Pneumonia: 80% Bacteremia: 20%	No	3	20%/No data	0%
de Bruyn et al[16]	14	1992-2003	Lung	1.3 yr (9.6 mo-2.3 yr)	Pneumonia: 78% Bacteremia: 21%	100%	23F, 19A, 6	No data	7.10% (1/14)
Kumar et al[9]	21	1995-2004	Kidney: 11 Liver: 9 Lung: 1	2.7 yr (1.3 mo-23.8 yr)	Pneumonia: 57% Bacteremia: 33% Peritonitis: 5% Parotitis: 5%	23.80%	23F, 22F, 19F	No data	28.60% (6/21)

IPD: Invasive pneumococcal disease.

Table 2 Pneumococcal vaccination studies in kidney transplantation in adult recipients

Ref.	N	Time since transplant	Vaccine	Technique	Response to immunization	Long term immune response
Silberman et al[59]	27 KT vs 24 healthy adults	7-108 mo	14-valent	Indirect hemagglutination	4-fold increase in titers, equivalent to controls	Not studied
Marrie et al[60]	63 KT vs 8 healthy adults	3-99 mo	14-valent	RIA	2.8-fold increase in titers in KT vs 3.4-fold in controls	GMT in KT: 872 ng N/mL post-vaccine 659 ng N/mL at 12 mo
Cosio et al[61]	25 KT (14 asplenia) vs 14 healthy adults	3-118 mo	14-valent	RIA	2-fold increase in titers in 93% of 14 healthy adults vs 78% of 14 splenectomized KT and 55% of 11 non-splenectomized KT patients	Not studied
Linneman et al[62,63]	104 KT (79 asplenia) vs 33 patients in hemodialysis	No data	14-valent	RIA	1.4-fold increase in antibody titers: 91%GMT post-vaccine with lower response in splenectomized KT vs non-splenectomized KT patients (394 vs 626 ng N/mL, P < 0.05) GMT post-vaccine with lower response in KT patients before 6 mo after transplant vs hemodialysis patients (303 vs 592 ng N/mL, P < 0.05)	GMT at 24 mo in 33 KT: 932 ng N/mL post-vaccine 385 ng N/mL at 24 mo 536 ng N/mL at revaccination
Arnold et al[64]	75 KT (32 asplenia) vs 60 healthy controls	> 12 mo	14-valent	Serum opsonizing antibody	2-fold increase in titers to serotypes 12F and 14 No differences in splenectomized vs non-splenectomized KT recipients	Not studied
Rytel et al[65]	61 KT (57 asplenia) vs 23 patients in dialysis vs 9 healthy controls	> 6 mo	14-valent	RIA	Equivalent protective GMT titers vs controls	Equivalent at 1, 2, and 3.5 yr vs controls
Kazancioglu et al[69]	21 KT vs 25 healthy controls	> 2 mo	PPV23	ELISA	Protective response to vaccination (40% increases in the antibody concentration) in 95.2% of KT at 1.5 and 3 mo after vaccination	Not studied
Kumar et al[78,79]	30 KT (PPV23) vs 30 KT (PCV7)	3 mo-3 yr	PPV23 vs PCV7	ELISA, OPA	Response to at least 1 serotype: no significant differences in antibody titers between PPV23 and PVC7, both using ELISA (53.3% vs 73.3%) and OPA (83.3% vs 80%)	Vaccine responses decline significantly after 3 yr and conjugate vaccine does not improve the durability of response

KT: Kidney transplantation; PPV23: 23-valent pneumococcal polysaccharide vaccine; PCV7: 7-valent pneumococcal conjugate vaccine; RIA: Radioimmunoassay; ELISA: Enzyme-Linked ImmunoSorbent Assay; OPA: Opsonophagocytic assay; GMT: Geometric Mean Titer.

Table 3 Pneumococcal vaccination studies in heart and liver transplantation in adult recipients

Ref.	n	Type and time since transplant	Vaccine	Technique	Response to immunization	Long term immune response
McCash- land et al[68]	25 LT vs 13 healthy controls	LT 1 - 6 mo	PPV23	ELISA	Pneumococcal antibody levels were significantly increased over baseline by 1 mo after vaccination in both groups	At 6th mo: antibody levels declined faster in patients than in control subjects
Amber et al[15]	6 HT before and after transplantation	HT 0.6 - 5.3 mo	Unva- ccinated	RIA	Protective antibody titers to 12 pneumococcal serotypes contained in PPV23 in a mean of 8.7 ± 1.2 serotypes before transplantation vs 6.5 ± 1.4 serotypes after transplantation (P < 0.05)	Not studied
Dengler et al[66]	16 HT vs 23 healthy controls	HT > 12 mo	PPV23	ELISA	Protective post-vaccine antibody titers (> 1000 U/mL): 94% in HT recipients vs 100% in controls	Not studied
Blumberg et al[67]	35 HT vs 35 healthy controls. Group 2 (n = 21), vaccinated before this study The HT patients were classified as: Group 1 (n = 11), no vaccinated before this study No data about previous vaccine (n = 2)	HT 55 - 122 mo	PPV23	ELISA	Post-vaccine antibody titers were higher in group 2 than in group 1 for all pneumococcal serotypes (P < 0.05 for all serotypes, except 3)	Detectable antibody titers at 24 mo (only 7 available patients) in 50% to serotypes 19F and 23F and in 80% to serotype 3

LT: Liver transplantation; HT: Heart transplantation; PPV23: 23-valent pneumococcal polysaccharide vaccine; ELISA: Enzyme-Linked ImmunoSorbent Assay; RIA: Radioimmunoassay.