Volume 82, Issue 2, Pages (July 2012)

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Volume 82, Issue 2, Pages 212-219 (July 2012) Mycophenolate and lower graft function reduce the seroresponse of kidney transplant recipients to pandemic H1N1 vaccination William R. Mulley, Kumar Visvanathan, Aeron C. Hurt, Fiona G. Brown, Kevan R. Polkinghorne, Tasoula Mastorakos, Michelle C. Lewicki, Rhonda L. Stuart, Sven-Jean Tan, Roy Chean, Peter G. Kerr, John Kanellis Kidney International Volume 82, Issue 2, Pages 212-219 (July 2012) DOI: 10.1038/ki.2012.106 Copyright © 2012 International Society of Nephrology Terms and Conditions

Figure 1 Study design. Participants were included in the complete analyses of the study if they received vaccination and had both pre- and post-vaccination serology performed. Baseline seroprotection levels were determined using serology from all participants who had blood taken before vaccination. Kidney International 2012 82, 212-219DOI: (10.1038/ki.2012.106) Copyright © 2012 International Society of Nephrology Terms and Conditions

Figure 2 Reverse cumulative distribution curve of antibody titers in kidney transplant recipients. (a) Patients taking mycophenolate had a lower rate of seroprotection post vaccination compared with those not taking mycophenolate despite a similar pre-vaccination seroprotection rate. Seroprotection is defined as having an antibody titer of ≥40 (gray dotted vertical line). (b) Post-vaccination seroprotection was modified by renal function, with patients with the lowest estimated glomerular filtration (eGFR) achieving the lowest rate of seroprotection despite similar pre-vaccination seroprotection rates. Seroprotection is defined as having an antibody titer of ≥40 (gray dotted vertical line). HAI, hemagglutination inhibition assay; MV, monovalent vaccine. Kidney International 2012 82, 212-219DOI: (10.1038/ki.2012.106) Copyright © 2012 International Society of Nephrology Terms and Conditions

Figure 3 Dose effect of mycophenolate on likelihood of achieving new seroprotection. Patients taking higher doses of mycophenolate (≥2g per day) achieved a significantly lower rate of seroprotection compared with those on <2g per day or on no mycophenolate after adjustment. CKD, chronic kidney disease. Kidney International 2012 82, 212-219DOI: (10.1038/ki.2012.106) Copyright © 2012 International Society of Nephrology Terms and Conditions