Measles Seroprotection in Pediatric Kidney and Liver Transplant Recipients During a Measles Resurgence

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ID: 327363
2026
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Abstract
Abstract Background Solid organ transplant (SOT) recipients are at risk for measles due to lifelong immunosuppression affecting cellular immunity, inability to routinely receive live viral vaccines and increasing number of measles outbreaks. A significant proportion of pediatric SOT candidates and recipients lack serologic protection against measles, with immunity waning over time. In the setting of recent measles outbreak in Texas, we set to understand protection levels in a small cohort of pediatric SOT patients followed at our institution. Methods We reviewed pediatric SOT patients age ≤ 21 years who had measured measles titers post-transplant in the past year. We aimed to determine the rates of seroprotection to measles in pediatric SOT recipients and understand variables associated with protection and its persistence. Results We reviewed 30 SOT recipients (Table 1), almost half transplanted before 3 years of age. Six had not received any MMR vaccination, 3 patients had received 1 dose prior to transplant and the remaining 21 patients had received ≥2. Twenty-one patients (70%) had positive titers to measles post-transplant, 63% and 67% had positive titers to mumps and rubella. Among patients with positive measles titers, only 1 had received 1 dose of MMR and the rest had received 2 or more. Of the patients with negative titers to measles, only 1 had received 2 doses of measles vaccine prior to transplant, 2 had only received 1 dose and 6 had not received any doses. For patients with pre-transplant titers available, all patients who had baseline positive titers to measles continued to have positive titers, although a significant decay in titers was noted for measles, mumps and rubella post-transplant in all patients. Only 2/9 (22.2%) of patients with negative post-transplant titers met the criteria to vaccinate delineated in the 2018 concensus meeting on live virus vaccines after SOT. A subset of our cohort will have measles specific T-cell immunity via ELISPOT measured in our lab to add to our understanding of correlates of protection to measles in SOT. Conclusion Measles seroprotection remains suboptimal in pediatric SOT. Even with guidelines on live viral vaccines post SOT, several patients remain ineligible for vaccination. This data and the overall understanding that protective titers may not necessarily correlate with disease protection highlights the continuous need for high percentages of vaccination and herd immunity to protect vulnerable individuals. Data on cellular immunity to measles is needed in SOT recipients to improve our understanding of true protection.
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Authors alison Purcell, Ranithri Patuwathavithane, Joshua Hales, Gilhen Rodriguez, Rita Swinford, Essam Imseis, Gabriela Bianco, Ramia Zakhour
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Journal journal of the pediatric infectious diseases society
Year 2026
DOI
10.1093/jpids/piag070/piag070.071
URL
https://academic.oup.com/jpids/article-pdf/15/Supplement_2/S31/70833278/piag070.071.pdf
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