Solid Organ Transplant (Table 5)
Donors and Patients Before Transplantation
88. Living donors should be current with vaccines based on age,
vaccination history, and exposure history according to the
CDC annual schedule (SR-H), but MMR, MMRV, VAR, and ZOS
administration should be avoided within 4 weeks of organ donation
(WR-VL). Vaccination of donors solely for the recipient's benefit is
generally not recommended (WR-L).
89. Adults and children with chronic or end-stage kidney, liver, heart,
or lung disease including SOT candidates should receive all age-,
exposure history–, and immune status–appropriate vaccines based
on the CDC annual schedule for immunocompetent persons (SR-M).
90. The following persons should receive PCV13 as in
recommendations 27a-c: adults who are SOT candidates or have
end-stage kidney disease as well as pediatric patients who are
SOT candidates; those who are <6 years of age and have end-stage
kidney, heart, or lung disease; and those who are 6-18 years of age
and have end-stage kidney disease (SR-VL).
91. Adults and children age ≥2 years old who are SOT candidates or
have end-stage kidney disease should receive PPSV23 if they have
not received a dose within 5 years and have not received 2 lifetime
doses (SR-M). Patients with end-stage kidney disease should
receive 2 lifetime doses 5 years apart (SR-L). Adults and children
≥2 years of age with end-stage heart or lung disease as well as
adults with chronic liver disease including cirrhosis should receive
a dose of PPSV23 if they never have received a dose (SR-L). When
both PCV13 and PPSV23 are indicated, PCV13 should be completed
8 weeks prior to PPSV23 (SR-M).
92. Anti-HBs–negative SOT candidates should receive a HepB series
(SR-M), and if on hemodialysis and age ≥20 years they should
receive a high-dose (40 μg) HepB series (SR-M). If a postvaccination
anti-HBs concentration of ≥10 mIU/mL is not attained, a second
3-dose series of HepB (SR-L) (Alternative: 1 dose of HepB after
which anti-HBs is tested*) should be administered using the
standard dose (SR-M) or high dose* for children (WR-L) and the high
dose for adolescents* and adults (SR-L). Hepatitis A–unvaccinated,
undervaccinated, or seronegative SOT candidates (particularly liver
transplant candidates) ages 12–23 months (SR-M) and those ≥2
years (SR-M) should receive a HepA series.
93. Combined HepA-HepB vaccine can be used for SOT candidates
≥12 years of age* in whom both vaccines are indicated (SR-M).
94. HPV series should be administered to SOT candidates ages 11-26
years (SR-L to M).
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