Reduced humoral response to mRNA SARS-CoV-2 BNT162b2 vaccine in kidney transplant recipients without prior exposure to the virus
Reduced humoral response to mRNA SARS-CoV-2 BNT162b2 vaccine in kidney transplant recipients without prior exposure to the virus
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DOI：
10.1111/ajt.16615
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发表时间：
2021-05-07
影响因子：
8.8
通讯作者：
Katchman, Helena
中科院分区：
文献类型：
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作者：
Grupper, Ayelet;Rabinowich, Liane;Katchman, Helena
COVID-19 与移植受者的发病率和死亡率增加有关。目前还没有关于这些患者使用任何可用 SARS-CoV-2 疫苗的疗效数据。我们分析了 136 名肾移植受者完全接种 BNT162b2 (Pfizer-BioNTech) 后的体液反应，并将其与 25 名对照者进行了比较。为了排除之前接触过该病毒的可能性，仅纳入了 SARS-CoV-2 核衣壳蛋白血清学阴性的参与者。所有对照均对刺突蛋白产生阳性反应，而 136 名移植受者中只有 51 名 (37.5%) 血清学呈阳性 (p < .001)。对照组的平均 IgG 抗尖峰水平较高（研究组与对照组分别为 31.05 [41.8] 与 200.5 [65.1] AU/mL，p < .001）。与无效体液反应相关的变量包括年龄较大（比值比 1.66 [95% 置信区间 1.17-2.69]）、过去 12 个月内的高剂量皮质类固醇 (1.3 [1.09-1.86])、三重免疫抑制维持治疗 (1.43 [1.06-2.15]) 以及包含霉酚酸酯的治疗方案 (1.47) [1.26-2.27]）。对照组和接受者之间的副作用发生率相似，并且没有发现症状的存在和血清转化之间存在相关性。我们的研究结果表明，尽管接种了疫苗，大多数肾移植受者仍面临感染 COVID-19 的高风险。需要进一步研究提高接受者对疫苗接种反应的可能措施。
COVID-19 is associated with increased morbidity and mortality in transplant recipients. There are no efficacy data available regarding these patients with any of the available SARS-CoV-2 vaccines. We analyzed the humoral response following full vaccination with the BNT162b2 (Pfizer-BioNTech) in 136 kidney transplant recipients, and compared it to 25 controls. In order to exclude prior exposure to the virus, only participants with negative serology to SARS-CoV-2 nucleocapsid protein were included. All controls developed a positive response to spike protein, while only 51 of 136 transplant recipients (37.5%) had positive serology (p < .001). Mean IgG anti-spike level was higher in the controls (31.05 [41.8] vs. 200.5 [65.1] AU/mL, study vs. control, respectively, p < .001). Variables associated with null humoral response were older age (odds ratio 1.66 [95% confidence interval 1.17-2.69]), high-dose corticosteroids in the last 12 months (1.3 [1.09-1.86]), maintenance with triple immunosuppression (1.43 [1.06-2.15]), and regimen that includes mycophenolate (1.47 [1.26-2.27]). There was a similar rate of side effects between controls and recipients, and no correlation was found between the presence of symptoms and seroconversion. Our findings suggest that most kidney transplant recipients remain at high risk for COVID-19 despite vaccination. Further studies regarding possible measures to increase recipient's response to vaccination are required.