Therapy With m-TOR Inhibitors Decreases the Response to the Pandemic Influenza A H1N1 Vaccine in Solid Organ Transplant Recipients
Therapy With m-TOR Inhibitors Decreases the Response to the Pandemic Influenza A H1N1 Vaccine in Solid Organ Transplant Recipients
复制标题
DOI：
10.1111/j.1600-6143.2011.03692.x
复制
发表时间：
2011-10-01
影响因子：
8.8
通讯作者：
Perez-Romero, P.
中科院分区：
文献类型：
--
作者：
Cordero, E.;Perez-Ordonez, A.;Perez-Romero, P.
人们对接受免疫抑制剂方案的实体器官移植受者（SOTR）对疫苗接种的反应以及与H1N1-2009大流行性流感疫苗接种相关的免疫反应相关的排斥反应的可能性表示担忧。本研究的目的是评估大流行疫苗在SOTR中的免疫原性、有效性和安全性。我们在接受大流行疫苗的SOTR中进行了一项多中心前瞻性研究。通过微量中和试验测定疫苗接种后5周血清中的免疫应答，并通过ELISA测定免疫球蛋白。包括346个SOTR。在13.6%的病例中检测到预先存在的血清保护，疫苗接种后的血清转换率和血清保护率分别为73.1%和82.9%。具有基线抗体滴度的患者在大流行疫苗接种后具有更好的几何平均滴度（GMT）（339.4对121.4，p < 0.001）。年轻、肝病和m-TOR抑制剂治疗与较低的血清保护和GMT后独立相关。没有严重的不良反应或排斥反应。大流行疫苗在SOTR中是安全的，并引起了足够的反应，尽管低于健康个体。这是第一项描述接受mTOR抑制剂的患者接种疫苗后反应下降的研究，这些患者的血清保护率较低，GMT后较低。
Concern has been raised regarding the response to vaccination in solid organ transplant recipients (SOTR) undergoing immunosuppressant regimens and the possibility of rejection related to the immune response associated with pandemic influenza H1N1-2009 vaccination. The goal of this study was to assess the immunogenicity, efficacy and safety of the pandemic vaccine in SOTR. We performed a multicenter prospective study in SOTR receiving the pandemic vaccine. Immunological response was determined in serum 5 weeks after vaccination by microneutralization assays, and immunoglobulins were measured by ELISA. Three hundred and forty-six SOTR were included. Preexisting seroprotection was detected in 13.6% of cases and rates of seroconversion and seroprotection after vaccination were 73.1% and 82.9%, respectively. Patients with baseline antibody titers had better geometric mean titers (GMT)-post after pandemic vaccination (339.4 vs. 121.4, p < 0.001). Younger age, liver disease and m-TOR inhibitor therapy were independently associated with lower seroprotection and GMT-post. There were no major adverse effects or rejection episodes. Pandemic vaccine was safe in SOTR and elicited an adequate response, although lower than in healthy individuals. This is the first study describing a decreased response after vaccination in patients receiving mTOR inhibitors who presented lower seroprotection rates and lower GMT-post.