Live Attenuated Influenza Vaccine in Pediatric Liver Transplant Recipients: A Retrospective Series

BACKGROUND: Influenza remains a significant cause of morbidity and mortality in pediatric patients, particularly among solid organ transplant (SOT) recipients. Live attenuated influenza vaccines (LAIV) historically have been contraindicated in SOT recipients, with very limited data on the safety of administration after SOT. METHODS: We report on the general safety outcomes of a series of four pediatric liver transplant recipients who received LAIV as a part of clinical care between 2019 and 2025 due to prior severe local reaction to the inactivated influenza vaccine (IIV). All patients met specific eligibility criteria for LAIV. Electronic medical records were reviewed. RESULTS: Among 15 administered doses, there were no serious adverse events and only three reports of mild symptoms within the 30 days following vaccination that could not be definitively attributed to LAIV. There were four confirmed influenza infections across two patients that occurred 45 days or more postvaccination; these were mild and did not require emergency department visits or hospitalization. CONCLUSIONS: In this cohort of four pediatric liver transplant recipients with severe localized side effects after IIV, LAIV was well-tolerated without significant safety events, which suggests that safety and immunogenicity of LAIV should be further explored in transplant recipients.