Impact of a Pharmacist-Led Vaccine Recommendation Program for Pediatric Kidney Transplant Candidates

Introduction: Previous studies have shown that a significant proportion of pediatric transplant recipients have incomplete age-specific vaccination schedules at the time of transplantation. Currently, no published studies have described the role of a transplant pharmacist in improving immunization rates for this vulnerable population.

Objectives: To evaluate the impact of transplant pharmacist interventions on the completion rate of vaccination schedules at the time of transplant. 

Study Design: Single-center, retrospective study

Methods: Pediatric kidney transplant recipients with available vaccine records who underwent transplantation between 1/1/12 and 9/30/15 were included. We compared patients who received pharmacist-led vaccination recommendations prior to transplant to a control group without pharmacist recommendations. Intervention began 1/1/14 and included assessment of vaccination status at time of initial evaluation according to the CDC immunization schedule and provision of recommendations for a vaccination catch-up schedule.

Results: Forty-seven pediatric patients were included. The intervention and control groups included 29 and 18 patients, respectively. Overall, the mean age was 11 (range 1-18) years at transplant and a majority was Hispanic (60%), female (53%), and recipients of a deceased donor transplant (89%). Baseline characteristics were similar between groups. The median percentage of up-to-date vaccinations at the time of evaluation was 80% in both groups [p=0.62]. The median percentage of up-to-date vaccinations at the time of transplant was significantly higher in the intervention group (90%; IQR 82-100%) vs. the control group (80%; IQR 71-80%) [p= 0.0008]. No patient was admitted for a vaccine-preventable infection within 6 months post-transplant.

Conclusions:

In this cohort, not all patients were fully immunized at the time of evaluation; however, with pharmacist intervention, significantly more patients were up-to-date with vaccination schedules at the time of transplant. These results suggest that a transplant pharmacist may serve as a valuable resource to increase immunization schedule compliance between time of evaluation and transplantation.