Humoral Immune Response of Kidney Transplant Recipients to Pneumococcal Vaccine

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Abstract
We immunized 63 renal transplant patients and 8 control subjects with a pneumococcal vaccine containing 14 capsular polysaccharides. The antibody levels to 12 of these polysaccharides were determined by a radioimmunoassay technique. The control subjects had antibody levels determined prior to and after immunization. The patients were divided into three groups on the basis of their underlying renal disease—Group 1, those with glomerulonephritis; Group 2, those with pyelonephritis; and Group 3, those with other renal diseases. Twenty-four Group 1, 9 Group 2, and 18 Group 3 patients had antibody levels determined before, 1 month and 1 year after immunization. The overall immune response of the patients 1 month after vaccination was not significantly different from that of the control subjects. The geometric mean antibody level at 1 year had declined by 13.8, 37.1, and 32.7% from the 1-month level for Groups 1, 2, and 3, respectively. An increasing dose of azathioprine resulted in a decreasing antibody response only in patients whose underlying disease was glomerulonephritis. An increasing dose of prednisone had a similar depressant effect in patients who had no apparent immunological disorder as the cause of failure of their own kidneys. Immunization did not adversely affect renal function. To date, no cases of pneumococcal pneumonia or bacteremia have occurred in the vaccinated patients; but, because of the small number of patients, a much larger period of observation is needed to determine the vaccine's efficacy.