Abstract
BACKGROUND: Pediatric solid organ transplant (SOT) recipients are at increased risk of vaccine preventable diseases (VPD) due to both under-vaccination and ineffective responses to vaccines while immunosuppressed. Current guidelines recommend timely post-transplant immunization with non-live vaccines and surveillance of vaccine-specific titers to assess vaccine responses; however, institutional adherence to these recommendations may be variable. METHODS: This single-center retrospective study of 199 pediatric SOT recipients (59 heart, 10 intestinal/multi-visceral, 34 kidney, and 96 liver) evaluated guideline adherence to post-vaccine serologic monitoring and identified sociodemographic and clinical factors associated with delayed and incomplete schedules for routine childhood non-live vaccines after transplant. RESULTS: Serologic monitoring was utilized after only 8% of recommended vaccines, while participants' age at transplant (odds ratio [OR], 95% confidence interval [CI]: 0.86, 0.81-0.91), receipt of a heart transplant (OR, 95% CI: 0.32, 0.17-0.60), and coverage with private insurance (OR, 95% CI: 0.46, 0.25-0.85) were factors negatively associated with timely initiation or completion of non-live vaccines after transplant. CONCLUSIONS: The associations between age at transplant, heart transplantation, and type of insurance with under-immunization warrant further investigation to address modifiable gaps in vaccine coverage and ensure pediatric SOT recipients are optimally protected from VPD.