Protecting your body and your new kidney from infections as best as possible is important, especially after transplantation. In this article you will learn why keeping your vaccinations up-to-date is important for you, which vaccinations are relevant for you and what things you may have to consider.
Taking immunosuppressants is essential for you and your organ after the transplant. Immunosuppressants are a group of drugs that slow down the reactions of your body's defense system (=immune system) and thus ensure that your new kidney can be accepted by your body. Because your immune system cannot work as effectively as before, vaccinations play an important in protecting you and your transplant from any threats.
Why are vaccinations important after transplantation?
The helpful functions of your immune system are severely limited by immunosuppressants. This means that your immune system has a hard time fighting the triggers of infections such as viruses, fungi and bacteria. Protecting your body with vaccinations is all the more important.
With a vaccination you can prepare your immune system for certain causes of infections (=pathogens) so that diseases do not break out in the first place. We will see later that for various reasons it is particularly advisable to ensure that your vaccinations are up-to-date vaccination even before transplantation. This applies to adults as well as to children and adolescents.
Which vaccines are suitable for you after transplantation?
In order to understand which vaccines can be given without hesitation after transplantation, we first need to look at how vaccines work in general. Based on how they work, vaccines can be divided into two different groups.
1. Inactive vaccines
In this group of vaccines, only inactive (=dead) pathogens or parts of the pathogen are used for vaccination. This means that the pathogen itself can no longer reproduce and cannot cause disease (=inactive vaccination).
These vaccines are also suitable after kidney transplantation. Despite the immunosuppression and the weakened immune system, they cannot cause any infections in your body. As always, it is best to talk to your medical team about vaccinations. Because of your immunosuppression, your vaccinations will need to be refreshed more frequently than in people with a functioning immune system. Together you can draw up a vaccination schedule. This will help you keep track of which vaccinations need a boost and when this boost needs to happen.
2. Live vaccines
The vaccines in this group should be avoided. These vaccines contain weakened forms of live pathogens that are still able to reproduce to a limited extent. Because the pathogens are active, these vaccines are called live vaccinations.
Live vaccines are not a problem for a healthy person, as the immune system of a healthy person is able to keep these pathogens in check. Therefore, if the immune system is functioning properly, live vaccinations do not usually cause any symptoms of disease. However, the body simultaneously creates protective antibodies to defend against the pathogens in the future. If your immune system is less active due to immunosuppression, it may not be able to fight the pathogens. As a result, there is a risk that the pathogens administered by vaccination will actually cause the disease in your body.
Live vaccines are used in many countries. Examples of live vaccinations include those against mumps, measles, rubella, and chickenpox/shingles. Your nephrologist has a good overview and will recommend the right vaccinations for you.
Why might you require vaccinations before your transplant?
Vaccination with live vaccines after kidney transplantation is not recommended due to immunosuppression. Therefore, these vaccines in particular should be up-to-date at the time of transplant. In addition, inactive vaccines are less effective due to immunosuppression, so these vaccines should also have been refreshed prior to transplant.
Which vaccinations are recommended for you?
At the latest, you should dig out your vaccination card from the cupboard and check whether your vaccination protection is still up to date as soon as you have been cleared for transplantation. Prior to transplantation, all vaccinations recommended by the Standing Commission on Vaccination (STIKO) should be administered. In addition, protection against hepatitis A and seasonal flu is recommended. If you have any questions or uncertainties, please feel free to contact your treating medical team at any time. They can advise you on the individual vaccinations and make individual recommendations for you. We have also prepared an overview of the most important vaccinations for you below.
1. These vaccinations should have been given before transplantation:
- Inactive Vaccinations:
- Hepatitis A & B
- Seasonal flu vaccination
- Tetanus & Diphtheria
- Pneumococcus (causative agent of bacterial pneumonia)
- Haemophilus influenzae (bacteria that live on mucous membranes and can cause serious illnesses)
- in individual cases, HPV vaccination after consultation (human papillomaviruses are associated with various wart formations and cervical cancer)
- Live vaccinations:
- Mumps, measles, rubella (in the absence of antibodies or prior vaccination).
- Varicella zoster virus (virus causing chickenpox and shingles)
2. These vaccinations are recommended for all patients after transplantation:
3. These vaccinations are recommended after transplantation for patients at risk:
4. These (live) vaccinations are not recommended after transplantation:
- Measles, mumps, rubella
- Chickenpox or shingles
- Tuberculosis
- Yellow fever - necessary for travel to regions in Africa and South America
- Oral typhoid vaccine
When should you get vaccinated before a transplant?
For people with renal insufficiency, planning for all necessary vaccinations should begin when the glomerular filtration rate (= eGFR) is less than 30 ml/min/1.73 m² of body surface area - that is, at stage 4 of chronic kidney disease (CKD 4). From CKD stage 5 onwards, the effect of the vaccine may be impaired, which is why the vaccinations should ideally be carried out before then.
When can you start getting vaccinated after your transplant?
After your transplant, you should ideally wait 6 months before getting vaccinated. This is because the dosage of immunosuppressants is particularly high immediately after transplantation, which is why vaccination is not as effective during this period.
An exception can be made for the seasonal flu vaccine. Since the timing of transplantation cannot be planned in the long term and this vaccination should be refreshed every year, flu vaccination can be given in individual cases from the fifth week after transplantation. Since the effect at this time is not yet reliable, a booster vaccination should be considered after 3 to 6 months.
