Information for doctors and patients in solid organ transplantation (SOT) – kidney, heart, liver, lung

Candidates (before organ transplantation)

The goal is to complete vaccination as much as possible before the surgery.

First – check written vaccination records or perform serological blood testing for antibodies.

Live vaccines (≥4 weeks before SOT):

• MeaslesMumpsRubella (2 doses)
• Varicella (2 doses)
• Tuberculosis – contraindicated (if already given → consult a TB specialist)

Inactivated vaccines:

• Hepatitis B – double dose, 3-4 doses
• Hepatitis A – for liver transplant candidates and seronegative individuals
• Human papillomavirus – 3 doses for everyone from age 9
• Pneumococcal infection (PCV10/13/15/20) – mandatory
• Haemophilus influenzae type b – plus 1 dose after age 5
• Influenza – annually; for children 6 months–9 years at first vaccination → 2 doses (if only 1 dose was received in the first year → 2 doses the next year)
• Meningococcal infection ACWY + B – as indicated
• COVID-19 – primary series + boosters every 6 months
• RSV – 1 dose ≥75 years

Organ donors

The goal is to protect the donor before organ retrieval.

• All routine vaccines according to age
• Influenza – if the transplantation takes place during the influenza season
• COVID-19 – per Order of the Ministry of Health of Ukraine No. 1380
• Live vaccines – give earlier, no later than 4 weeks before organ retrieval

Recipients (after organ transplantation)

The goal is to resume vaccination taking immunosuppression into account.

Timeline:

• 0-2 months → vaccination is contraindicated (exception: influenza after 4 weeks in case of an epidemic threat)
• 2-6 months → start of vaccination with inactivated vaccines (kidney, heart, liver)
• 6 months → full range of inactivated vaccines (especially after lung transplantation)
• 12 months → live vaccines may be considered in children with minimal immunosuppression and if the immune criteria are met

Inactivated vaccines:

• Influenza – annually; in the first year after SOT → 2 doses
• COVID-19 – complete the primary series + boosters every 6-12 months
• Hepatitis B – double dose, monitor anti-HBs IgG titer, booster if <10 mIU/ml
• Hepatitis A – 2 doses for seronegative individuals
• Pneumococcal infection – PCV13/15/20 or PCV13/15 + PPSV23
• Meningococcal infection ACWY + B – primary course + boosters
• Human papillomavirus – 3 doses regardless of age
• RSV – 1 dose ≥60 years
• Herpes zoster – ≥18 years, 2 doses of the recombinant vaccine
• Others ( Rabies, Tick-borne encephalitis, mpox, Japanese encephalitis, Typhoid fever, cholera) – only as indicated

Live vaccines:

• Contraindicated in almost all cases
• Exceptions – vaccines against MeaslesMumpsRubella and against Varicella may be possible ≥12 months after SOT in children with minimal immunosuppression and if the immune criteria are met (depending on CD4 lymphocyte / IgG levels – under the supervision of an immunologist)

Family members and close contacts

The goal is to minimize the risk of transmitting infections to the recipient.

• Influenza — annually (family, close contacts, healthcare workers)
• COVID-19 — vaccination and revaccination
• Hepatitis A — ≥12 months, seronegative individuals at risk
• Pertussis — DTP/DTaP for children, Tdap for adults
• Polio — IPV only (OPV is contraindicated for contacts)
• Rotavirus infection — not contraindicated for children, but recipients should avoid contact with infants' diapers for 4 weeks after vaccination
• Live influenza vaccine — avoid contact with the recipient for 7 days