Kidney Transplant Patients May Not Be Protected From HPV Strains in Vaccines Interview with:

Dr. Delphine Robotham MD Division of Pediatric Nephrology Johns Hopkins University School of Medicine Baltimore, Maryland

Dr. Robotham

Dr. Delphine Robotham MD
Division of Pediatric Nephrology
Johns Hopkins University School of Medicine
Baltimore, Maryland

Medical Research: What is the background for this study? What are the main findings?

Response: Cervical cancer is the second most common cancer in women worldwide and is almost entirely caused by high risk HPV genotypes.  Vaccines to high risk HPV genotypes have shown great success in protecting healthy women from the sequelae of infection, including cervical cancer and genital warts. Young women with a kidney transplant as well as those with chronic kidney disease have abnormal immune systems and as a result have a significantly increased burden of HPV-related disease making the potential health benefits of the HPV vaccine substantial in this particularly vulnerable population.  This study examined the immune response to the HPV vaccine among girls and young women with kidney disease.

The goal of this research was to determine if girls and young women with chronic kidney disease (abnormal kidney function, on dialysis, or post kidney transplant) showed evidence of immune response to the quadrivalent HPV vaccine.  Immune response was determined by measuring the amount of antibody made by the patients against each of the 4 HPV genotypes included in the vaccine.  There are established thresholds of antibody above which patients are believed to have protection from infection.  We found that study participants with chronic kidney disease and those on dialysis had antibody levels above the threshold, indicating the vaccine should be effective in protecting them from HPV related disease.  A significant proportion of patients with kidney transplants showed evidence of inadequate antibody response.  This is important information as it means patients with a kidney transplant, whom we know are at increased risk of developing cervical cancer from HPV infection, may not be protected from HPV infections from the HPV genotypes included in the vaccine.

Medical Research: What should clinicians and patients take away from your report?

Response: As mentioned above, not only is cervical cancer the second most common cancer in women worldwide, patients who are post kidney transplant are also at significantly increased risk of the development of cervical cancer if infected with disease causing HPV strains.  In 2014, a national survey found that only 60% of girls aged 13–17 years had received at least 1 dose of the HPV vaccine, and 40% had received all 3 doses in the series.  I would hope after reading this report physicians will be reminded to discuss the importance of the HPV vaccine with all of their eligible patients.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: Further study is needed not only to determine the best vaccine regimen in transplant patients, but also to determine if vaccination prior to transplantation confers adequate protection to girls and young women post transplantation.


Clin J Am Soc Nephrol. 2016 Apr 7. pii: CJN.09690915. [Epub ahead of print]

Immunogenicity of Human Papillomavirus Recombinant Vaccine in Children with CKD.

Nelson DR1, Neu AM2, Abraham A3, Amaral S4, Batisky D5, Fadrowski JJ2.

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Last Updated on April 15, 2016 by Marie Benz MD FAAD