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Principles of immunisation in children with solid organ transplant
  1. Chayarani Kelgeri1,
  2. Dominic F Kelly2,
  3. Alexandra Brant1,
  4. Mitul Patel3,
  5. Girish L Gupte1
  1. 1 Department of Paediatric Hepatology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
  2. 2 Department of Paediatrics, University of Oxford, Oxford, Oxfordshire, UK
  3. 3 Department of Microbiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
  1. Correspondence to Dr Chayarani Kelgeri, Paediatric Hepatology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham B4 6NH, UK; chayarani.kelgeri{at}


Vaccine-preventable diseases (VPD) are a significant risk to paediatric solid organ transplant (SOT) recipients on lifelong immunosuppressive therapy. Children progressing to end-stage organ dysfunction are unable to mount a robust immune response. Hence, it is important to plan vaccination early in the course of disease, especially if a child is anticipated to be a SOT candidate. Vaccine recommendations need to be individualised in this population based on vaccine history and serology. Catch-up or accelerated schedules may be used to complete vaccinations before transplant. Post-transplant, immunisation is recommenced in consultation with the transplant team taking into context the time since transplant and the intensity of the immunosuppressive regime. Inactivated vaccines are safe post-transplant but postexposure prophylaxis may still be required in children with inadequate immunity to VPD. Specific vaccines may be advised for SOT recipients travelling abroad (in consultation with a travel clinic) or those entering high-risk professions. Additionally, the vaccination status of all household members and close contacts should be reviewed and optimised, offering additional protection to the transplant recipient.

  • epidemiology
  • therapeutics
  • virology

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  • Contributors CK drafted the article and did the literature search. DFK provided expert input and helped in shaping the manuscript. AB edited the manuscript and contributed to the box tables of the manuscript. MP provided critical feedback and helped in shaping the manuscript. GG provided critical feedback, supervised and coordinated the writing of this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data sharing not applicable as no datasets generated and/or analysed for this study. No data used.

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