Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA.
Am J Nephrol. 2012;36(3):201-7. doi: 10.1159/000341653. Epub 2012 Aug 17.
BACKGROUND/AIMS: Although annual influenza vaccination is recommended for kidney transplant recipients, efficacy as reflected by serum antibody titers has not been well studied beyond 1 month in kidney transplant recipients.
We performed a single-center prospective cohort study of 51 kidney transplant recipients and 102 healthy controls receiving the 2006-2007 influenza vaccine. Anti-hemagglutinin antibody titers to A/H1N1, A/H3N2, and B were measured before and 1 month after vaccination, and again at the end of influenza season. The primary outcome was the proportion of participants maintaining seroprotection (antibody titer ≥1:32) for the duration of the influenza season after influenza vaccination.
Median follow-up time was 175 and 155 days in the transplant and control groups, respectively. For types A/H1N1 and B, a similar high proportion of the transplant and control groups (88.5 and 81.6% vs. 83.7 and 74.2% for A/H1N1 and B, respectively) maintained seroprotection. For type A/H3N2, significantly less of the transplant group (66.7%) versus the control group (90%) maintained a protective influenza vaccine response (odds ratio 0.21, 95% confidence interval 0.07-0.64). This difference disappeared in adjusted analyses. Actual geometric mean titers decreased significantly within both groups (p < 0.001) but this did not differ between groups.
Once they have developed protective vaccine-induced antibody responses to influenza vaccine, kidney transplant recipients are able to maintain adequate protective levels of antibody compared with healthy controls.
背景/目的:尽管推荐肾移植受者每年接种流感疫苗,但在肾移植受者中,血清抗体滴度反映的疫苗效力在 1 个月后尚未得到很好的研究。
我们对 51 例肾移植受者和 102 例健康对照者进行了一项单中心前瞻性队列研究,这些患者均接受了 2006-2007 年的流感疫苗。在接种疫苗前、接种后 1 个月以及流感季节结束时,检测抗血凝素抗体滴度对 A/H1N1、A/H3N2 和 B 的反应。主要结局是在接种流感疫苗后整个流感季节内,参与者保持血清保护(抗体滴度≥1:32)的比例。
移植组和对照组的中位随访时间分别为 175 天和 155 天。对于 A/H1N1 和 B 型,移植组和对照组保持血清保护的比例相似(分别为 88.5%和 81.6%比 83.7%和 74.2%)。对于 A/H3N2 型,移植组(66.7%)与对照组(90%)相比,保持保护性流感疫苗应答的比例显著降低(比值比 0.21,95%置信区间 0.07-0.64)。调整分析后,这种差异消失了。两组的实际几何平均滴度均显著下降(p < 0.001),但两组之间没有差异。
一旦肾移植受者对流感疫苗产生了保护性疫苗诱导的抗体反应,他们就能维持与健康对照组相当的足够的抗体保护水平。