Immunogenicity and safety of high-dose versus double-dose quadrivalent inactivated influenza vaccine in adult kidney transplant recipients: a randomized controlled trial (2023).

Authors

Thanachote Arayanumas, Kobporn Boonnak, Surasak Kantachuvesiri, Sarinya Boongird, Sasisopin Kiertiburanakul, Jackrapong Bruminhent

Published in

The Lancet regional health. Southeast Asia. Volume 55. Pages 100873. Epub Sep 25, 2026.

Abstract

Solid organ transplant (SOT) recipients are at increased risk of influenza-related complications and often exhibit suboptimal vaccine responses. While both high-dose (HD) and double-dose (DD) quadrivalent inactivated influenza vaccines (QIIV) aim to enhance immunogenicity compared to the standard dose, access to HD QIIV may be limited in resource-constrained settings. We evaluated whether DD QIIV could serve as a practical alternative.
We conducted open-label randomized controlled trial comparing the 2023 Southern Hemisphere HD QIIV containing 60 μg of antigen per strain with a double dose of standard QIIV containing 30 μg per strain in adult kidney transplant (KT) recipients. Pre- and 4-week post-vaccination sera were tested using strain-specific hemagglutination inhibition assays. Safety was also assessed.
Eighty-eight KT recipients were randomized and 84 were eligible for analysis (42 per group); 59.5% were male, with a mean age of 46 ± 11 years, and 60.7% received deceased donor kidneys. Seroconversion (SC) to ≥1 strain was significantly higher in the HD group (95.2%) than in the DD group (69%) (P = 0.002). The absolute difference in response rate was 0.26 (95% CI, 0.12-0.40). SC rates were numerically higher in the HD group for all strains. Injection site pain and myalgia were less common in the HD group, with P = 0.040 and P = 0.043, respectively.
HD QIIV demonstrated more favorable immunogenicity and tolerability than DD QIIV. These findings suggest that HD QIIV may be a preferable option for this population when available.
This study was supported by the Research grant from Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

PMID:
42831180
Bibliographic data and abstract were imported from PubMed on 05 Oct 2026.

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