Antibody responses after sequential vaccination with PCV13 and PPSV23 in kidney transplant recipients

Infection. 2023 Dec;51(6):1703-1716. doi: 10.1007/s15010-023-02054-3. Epub 2023 May 27.


Purpose: Vaccination against Streptococcus pneumoniae is recommended in transplant recipients to reduce the morbidity and mortality from invasive pneumococcal disease. Previous studies indicate that transplant recipients can produce specific antibodies after vaccination with the 13-valent pneumococcal conjugate vaccine Prevenar 13 (PCV13) or the pneumococcal polysaccharide vaccine Pneumovax 23 (PPSV23). National guidelines recommend sequential vaccination with PCV13 followed by PPSV23 in kidney transplant patients. However, there are currently no data on the serological response in kidney transplant recipients, who received a sequential vaccination with PCV13 and PPSV23.

Methods: In the current study, we sequentially vaccinated 46 kidney transplant recipients with PCV13 and PPSV23 and determined global and serotype-specific anti-pneumococcal antibody responses in the year following vaccination.

Results: Serotype-specific and global anti-pneumococcal antibody concentrations were significantly higher compared to baseline. We observed that serotype-specific antibody responses varied by serotype (between 2.2- and 2.9-fold increase after 12 months). The strongest responses after 12 months were detected against the serotypes 9N (2.9-fold increase) and 14 (2.8-fold increase). Global antibody responses also varied with respect to immunoglobulin class. IgG2 revealed the highest increase (2.7-fold), IgM the lowest (1.7-fold). Sequential vaccination with both vaccines achieved higher antibody levels in comparison with a historical cohort studied at our institute, that was vaccinated with PCV13 alone. During the 12-months follow-up period, none of the patients developed pneumococcal-associated pneumonia or vaccination-related allograft rejection.

Conclusion: In conclusion, we strongly recommend sequential vaccination over single immunization in kidney transplant recipients.

Keywords: Kidney transplantation; Pneumococcal antigens; Sequential vaccination; Serotype specific immunity; Streptococcus pneumoniae; Vaccination.

MeSH terms

  • Antibodies, Bacterial
  • Antibody Formation
  • Double-Blind Method
  • Humans
  • Kidney Transplantation*
  • Pneumococcal Infections* / prevention & control
  • Pneumococcal Vaccines
  • Streptococcus pneumoniae
  • Transplant Recipients
  • Vaccination
  • Vaccines, Conjugate


  • 13-valent pneumococcal vaccine
  • 23-valent pneumococcal capsular polysaccharide vaccine
  • Antibodies, Bacterial
  • Vaccines, Conjugate
  • Pneumococcal Vaccines