Barriers to Pre-Transplant Immunization: A Qualitative Interview Study of Pediatric Solid Organ Transplant Stakeholders

Objectives To describe the experiences and beliefs of pediatric transplant stakeholders regarding factors that contribute to low pre-transplant immunization rates. Study design Semi-structured interviews were conducted with transplant team members (hepatologists, cardiologists, nephrologists, transplant nurse coordinators and transplant infectious diseases physicians), primary care physicians, and parents of heart, liver and kidney transplant recipients at three geographically diverse large pediatric transplant centers in the United States. Interviews were conducted between July 2017 and February 2020 until thematic saturation was reached within each stakeholder subgroup. Content analysis methodology was utilized to identify themes. Results Stakeholders participated in 30-60-minute interviews (16 transplant subspecialists, 3 transplant infectious diseases physicians, 11 transplant nurse coordinators, 12 primary care physicians, and 40 parents). Five central themes emerged: (1) gaps in knowledge about timing and safety of pre-transplant immunizations, (2) lack of communication, coordination and follow-up between team members regarding immunizations, (3) lack of centralized immunization records, (4) subspecialty clinic functioning as the medical home for transplant candidates but unable to provide all needed immunizations and (5) differences between organ type in prioritization and completion of pre-transplant immunization. Conclusions There are multiple factors that contribute to low immunization rates amongst pediatric transplant candidates. New tools are needed to overcome these barriers and increase immunization rates in transplant candidates.