Editorial Comment Vaccination in solid-organ transplantation candidates: time for a benefit/risk assessment

In this issue of CKJ, Kaul et al. [1] report their experience regarding chicken pox infection after renal transplanta-tion. They found that the overall incidence is around 1%, somewhat lower than previously reported [2]. One of the major questions raised by this report is the vaccination policy before transplantation. The importance of vaccina-tion in solid-organ transplantation candidates has been emphasized because of the potential direct and indirect risk of infection or immunological complications and since some vaccines are contraindicated when patients are maintained on immunosuppression [3]. Furthermore, the use of new powerful drugs such as belatacept, rituximab, eculizumab or bortezomib may be associated with a higher incidence of infectious complications. In some cases, these complications are specific and vaccination is mandatory, e.g. antimeningococcemia vaccine and eculizumab treatment. The question to be raised, therefore, may be which ‘infec-tious preparation ’ should be used before transplantation, i.e. for solid-organ transplant candidates. Indeed, the tim-ing of vaccination administration in relation to end-stage renal failure is a key determinant of immunogenicity. For example, in the KDIGO guidelines, the only suggestion re-garding pre-transplantation concerns hepatitis B virus (HBV) vaccine, and they recommend a vaccination policy to be undertaken as early as possible [4]. Besides this classical specificity, the first question re-gards anogenital human papillomavirus (HPV) infections, which are associated with a substantial increased risk of developing cervical and anogenital cancers [5]. With the development of an HPV vaccine, some have advised the administration of this vaccine to females between 9 and 26 years who are candidates for solid-organ transplanta-tion. Indeed, this recommendation has been added in the commentary of the Canadian Society of Transplantation i