Evaluation of Antibody Responses in Hemodialysis Patients, Peritoneal Dialysis, Kidney Transplant Recipients and Normal Subjects after Administration of 23-Valent Pneumococcal Polysaccharide Vaccine

Abstract

Background: Pneumococcal vaccines are recommended in patients with immune deficiencies such as kidney transplant recipients and dialysis subjects. Streptococcus pneumoniae is an agent of pneumonia, meningitis, important morbidities and mortality in such patients. The purpose of this study was to evaluate and compare the antibody responses in hemodialysis patients, peritoneal dialysis, kidney transplant recipients and normal subjects after administration of 23-valent pneumococcal polysaccharide vaccine (PPV23). Materials and Methods: The present randomized clinical trial was conducted on 162 subjects including 57 hemodialysis patients, 29 peritoneal dialysis patients, 48 kidney transplant recipients, and 28 healthy controls. The participants received a single-dose pneumococcal vaccine (Pneumovax 23) of 0.5 ml in the upper limb muscle. The efficacy of vaccination was evaluated by measuring the antibody response to the entire vaccine. Serum samples were collected before, one and six months after vaccination. Results: The levels of IgG pneumococcal antibodies at pre-vaccination periods, one and six months after vaccination were 11.6±1.52 IU/ml, 14.98±1.98 IU/ml and 14.87±0.66 IU/ml in kidney transplant recipients, 12.03±1.93 IU/ml, 15.26±0.49 IU/ml and 14.3±0.72 IU/ml in hemodialysis patients, and 11.5±1.55 IU/ml, 15.2±1.81 IU/ml, and 14.2±1.7 IU/ml, respectively. The serum antibody level was significantly higher in kidney transplant recipients than in both dialysis groups after six months of vaccination (p=0.029). Conclusion: We found that patients with renal failure respond to pneumococcal vaccination in hemodialysis and kidney transplantation. However, they lost their serum antibodies within six months of vaccination. Determining the protective level for serum IGG and IGG2 in these patients helps us to follow up on these patients more precisely in order to re-vaccinate when the protective level of serum antibody is broken.