High immunogenicity of a messenger RNA-based vaccine against SARS-CoV-2 in chronic dialysis patients
High immunogenicity of a messenger RNA-based vaccine against SARS-CoV-2 in chronic dialysis patients
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DOI：
10.1093/ndt/gfab193
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发表时间：
2021-05-31
影响因子：
6.1
通讯作者：
Kamar, Nassim
中科院分区：
文献类型：
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作者：
Longlune, Nathalie;Nogier, Marie Beatrice;Kamar, Nassim
背景慢性肾病患者、透析患者和肾移植患者患严重2019年冠状病毒病（COVID-19）的风险很高。最近发表了关于透析患者中抗严重急性呼吸综合征冠状病毒2信使RNA（抗SARS-CoV-2 mRNA）疫苗的免疫原性的数据。我们评估了抗SARS-CoV-2 mRNA疫苗在透析患者中的免疫原性。109名接受血液透析（n=85）或腹膜透析（n=24）的患者接受了两次30 μ g剂量的BNT 162 b2 mRNA COVID-19疫苗（Pfizer-BioNTech）注射，间隔28天肌肉注射。第二次接种后血清反应仍呈阴性的受试者在1个月后接受第三次接种。免疫前后检测血清抗SARS-CoV-2抗体。在第二次（n=97）或第三次（n=5）疫苗接种后至少随访1个月的102名患者中，有91名患者出现抗SARS-CoV-2抗体。在SARS-CoV-2血清阴性患者中，在开始接种疫苗时，血清转换率为88.7%（97例患者中的86例）。接受免疫抑制治疗是疫苗接种无应答的独立预测因素。由于mRNA疫苗的高免疫原性和安全性，我们强烈建议透析患者优先接种两剂疫苗。对于两剂疫苗无反应的患者，可能需要第三剂疫苗。如果可能，等待肾移植的患者应在移植前接种疫苗。
Background. Patients with chronic kidney disease, dialysis patients and kidney transplant patients are at high risk of developing severe coronavirus disease 2019 (COVID-19). Data regarding the immunogenicity of anti-severe acute respiratory syndrome coronavirus 2 messenger RNA (anti-SARS-CoV-2 mRNA) vaccines in dialysis patients were published recently. We assessed the immunogenicity of anti-SARS-CoV-2 mRNA vaccine in dialysis patients.Patients and methods. One hundred and nine patients on haemodialysis (n=85) or peritoneal dialysis (n=24) have received two injections of 30-mu g doses of BNT162b2 mRNA COVID-19 vaccine (Pfizer-BioNTech) that were administered intramuscularly 28days apart. Those who were still seronegative after the second dose were given a third dose 1 month later. Anti-SARS-CoV-2 antibodies were tested before and after vaccination.Results. Ninety-one out of the 102 patients who had at least a 1-month follow-up after the second (n=97) or the third (n=5) vaccine doses had anti-SARS-CoV-2 antibodies. The seroconversion rate was 88.7% (86 out of 97 patients) among SARS-CoV-2 seronegative patients at the initiation of vaccination. Receiving immunosuppressive therapy was an independent predictive factor for non-response to vaccination.Conclusion. Due to high immunogenicity and safety of mRNA vaccines, we strongly recommend prioritizing a two-dose vaccination of dialysis patients. A third dose can be required in non-responders to two doses. When possible, patients waiting for a kidney transplantation should be offered the vaccine before transplantation.