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A Randomized, Double‐Blind, Placebo‐Controlled Trial to Evaluate the Prime‐Boost Strategy for Pneumococcal Vaccination in Adult Liver Transplant Recipients

2008; Oxford University Press; Volume: 47; Issue: 7 Linguagem: Inglês

10.1086/591537

1537-6591

Deepali Kumar, Maggie Hong Chen, Gary Wong, Isabel Cobos, Brenda Welsh, Deborah Siegal, Atul Humar,

Influenza Virus Research Studies

The 23-valent pneumococcal polysaccharide vaccine (PPV23) is recommended for disease prevention in solid-organ transplant recipients, but it may have suboptimal immunogenicity. It may be possible to enhance immunogenicity by priming the recipient with the 7-valent pneumococcal conjugate vaccine (PCV7), followed by boosting with PPV23.We randomized adult liver transplant recipients to receive either (1) PCV7 followed by a PPV23 booster 8 weeks later (the "primed" group) or (2) placebo followed by a standard single dose of PPV23 (the "unprimed" group). Quantitative and functional antibody titers for 7 serotypes contained in both vaccines were measured at baseline, 8 weeks after enrollment, and 16 weeks after enrollment. Of 130 randomized patients, 113 completed the study.At week 16, response to at least 1 serotype was seen in 48 (85.7%) of 56 and 52 (91.2%) of 57 patients for the primed and unprimed groups, respectively (P=not significant). The mean number of serotypes to have responded (+/-SD) was 307+/-2.3 and 4.4+/-2.2 for the primed and unprimed groups, respectively (P=not significant). Functional antibody titers, which were measured with use of the opsonophagocytic assay, were also similar in both groups.The immunogenicity of pneumococcal vaccination was not enhanced by the prime-boost strategy, compared with vaccination with PPV23 alone. Administration of a single dose of PPV23 should continue to be the standard of care for adult liver transplant recipients.NCT00152802 (http://www.clinicaltrials.gov).