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Background Live attenuated vaccines (LAVs) are currently contraindicated in immunocompromised patients such as solid-organ transplant (SOT) recipients. The guideline published by the Infectious Disease Society of America also cautions that LAVs after SOT are contraindicated. However, several articles have demonstrated that these patients may receive LAVs safely by adhering to a protocol consisting of an evaluation of many immunological parameters. The aim of this study was to evaluate the safety of LAVs, including measles, mumps, rubella, and varicella to liver transplant (LT) recipients under our clinically based immunization protocol for LT recipients. Methods We conducted a retrospective cohort study on the safety of live attenuated vaccines (LAVs) for measles, rubella, varicella, and mumps to LT recipients at the National Center for Child Health and Development from July 2010 to July 2019. Patients who underwent LT at age under 20 years, who visited our outpatient clinic for vaccination were included. Our institutional protocol for vaccination is shown in Table. Patients’ demographics, underlying diseases, administered vaccines, number and date of vaccination, and adverse events were extracted from their medical records. Adverse events occurring within 4 weeks after vaccination were collected and classified into 4 stages based on severity. Results During the study period, there were 1,904 outpatient clinic visits by 361 patients. Of these, multiple vaccines (median: 2, range: 1–7) including inactivated vaccines and LAVs were simultaneously administered during the 1,213 visits (64%). LAVs were administered to 422 times (209 patients) who met the criteria and included 225 doses of measles and rubella combination vaccine, 224 doses of varicella vaccine, and 215 doses of mumps vaccine. Underlying diseases included cholestatic liver disease (n = 125), followed by metabolic disease (n = 33), acute liver failure (n = 19). Eleven mild adverse events (2.6%) possibly associated with LAVs were reported, but there were no serious adverse events, including vaccine-strain infection, hospitalization, and death. Conclusion LAVs administration for LT recipients were safe without any serious adverse events under our relatively simplistic institutional protocol. However, further research is needed to closely monitor the efficacy and safety of LAVs to LT recipients.

#62: Safety of Live Attenuated Vaccines Administered after Pediatric Liver Transplantation