Improving Vaccinations in the Pediatric Transplant Population: 4-Year Quality Improvement Outcomes. Pediatr Transplant 2026 Jan;30(1):e70259
Date
01/07/2026Pubmed ID
41499382DOI
10.1111/petr.70259Scopus ID
2-s2.0-105026864387 (requires institutional sign-in at Scopus site)Abstract
BACKGROUND: An ongoing quality improvement process was used to increase live and inactivated vaccination rates among vaccine-eligible pediatric liver transplant patients.
METHODS: We evaluated 4-year outcomes (2019-2023) of Plan-Do-Study-Act (PDSA) cycles to guide vaccine counseling and management for pediatric liver transplant recipients. The annual posttransplant visit was used to provide families education regarding live and inactivated immunizations and obtain antibody titers for varicella, measles, mumps, rubella, Haemophilus influenzae type b, hepatitis A and hepatitis B. Vaccine recommendations were based on clinical criteria determined by our multidisciplinary team. Recommendations were then communicated with families and primary care providers (PCPs). Immunizations were administered by PCPs. Titers were obtained 4 weeks following immunization to assess response.
RESULTS: Fifty-four patients met inclusion criteria. Recommendations for live (n = 38) and inactivated (n = 49) vaccines were given to patients. At the end of cycle 4, there was a notable increase in the number of patients who achieved protective titers to all live and inactivated vaccines in comparison to the start of cycle 1. The protective antibody titers to live vaccines declined in nearly half of our patients (n = 23/54, 43%), with the majority being to varicella vaccine and a smaller number to measles vaccine. However, most patients who were reimmunized (n = 13/14, 93%) had protective antibody titers following booster administration. There were no serious adverse effects to live vaccines.
CONCLUSIONS: We successfully recommended vaccinations and documented vaccine-induced immunity by implementing an active vaccine education and screening program. For PDSA cycle 5, we plan to continue our current practice and offer vaccines in transplant clinic, an identified barrier to vaccination.
Author List
Alibrahim L, Gumm A, Knapp C, Rueter J, Huppler AR, Vitola B, Lerret SMAuthors
Anna Huppler MD Associate Professor in the Pediatrics department at Medical College of WisconsinStacee Lerret PhD Professor in the Pediatrics department at Medical College of Wisconsin
Bernadette Vitola MPH, MD Professor in the Pediatrics department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentChild
Child, Preschool
Female
Humans
Infant
Liver Transplantation
Male
Quality Improvement
Vaccination
Vaccines, Inactivated
