Influenza virus vaccination in kidney transplant recipients: serum antibody response to different immunosuppressive drugs

Clin Transplant. Jan-Feb 2010;24(1):E17-23. doi: 10.1111/j.1399-0012.2009.01095.x. Epub 2009 Sep 14.


Introduction: This study prospectively accessed the immune response to the inactivated influenza vaccine in renal transplant recipients receiving either azathioprine or mycophenolate mofetil (MMF). Side effects were investigated.

Methods: Sixty-nine patients received one dose of inactivated trivalent influenza vaccine. Antihemagglutinin (HI) antibody response against each strain was measured before and one to six months after vaccination.

Results: Geometric mean HI antibody titers for H1N1 and H3N2 strains increased from 2.57 and 2.44 to 13.45 (p = 0.001) and 7.20 (p < 0.001), respectively. Pre- and post-vaccination protection rates for H1N1 and H3N2 increased from 8.7% to 49.3% (p < 0.001); and 36.3% (p < 0.001) and seroconversion rates were 36% and 25.3%, respectively. There was no response to influenza B. The use of MMF reduced the H1N1 and H3N2 protection rates and the seroconversion rate for the H1N1 strain when compared with the use of azathioprine, and subjects transplanted less than 87 months also had inferior antibody response. Adverse events were mild and there were no change on renal function post-vaccination.

Conclusion: Renal transplant patients vaccinated against influenza responded with antibody production for influenza A virus strains, but not for influenza B. Use of MMF and shorter time from transplantation decreased the immune response to the vaccine.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antibodies, Viral / blood*
  • Azathioprine / administration & dosage
  • Female
  • Follow-Up Studies
  • Glucocorticoids / administration & dosage
  • Humans
  • Immunosuppressive Agents / administration & dosage*
  • Influenza A virus / immunology*
  • Influenza B virus / immunology*
  • Influenza Vaccines*
  • Influenza, Human / prevention & control
  • Kidney Diseases / blood
  • Kidney Diseases / immunology*
  • Kidney Diseases / surgery
  • Kidney Transplantation*
  • Male
  • Middle Aged
  • Mycophenolic Acid / administration & dosage
  • Mycophenolic Acid / analogs & derivatives
  • Vaccines, Inactivated
  • Young Adult


  • Antibodies, Viral
  • Glucocorticoids
  • Immunosuppressive Agents
  • Influenza Vaccines
  • Vaccines, Inactivated
  • vaxigrip
  • Mycophenolic Acid
  • Azathioprine