肾移植前后水痘-带状疱疹病毒的免疫应答。

Immune response to varicella-zoster virus before and after renal transplantation.

机构信息

Department of Rheumatology and Clinical Immunology, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands; Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands.

Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands.

出版信息

Antiviral Res. 2020 Nov;183:104938. doi: 10.1016/j.antiviral.2020.104938. Epub 2020 Oct 6.

DOI:10.1016/j.antiviral.2020.104938

PMID:32979400

Abstract

BACKGROUND

Herpes zoster (HZ) risk is high in renal transplant recipients. Vaccination prior to transplantation may provide a useful strategy for the prevention of HZ in the posttranplantation period. However, it is not known whether immunity to varicella-zoster virus (VZV) is affected due to treatment surrounding transplantation.

METHODS

Both humoral and cellular immunity to VZV were determined prior to and 2-3 years after renal transplantation in 60 adult patients, and 62 matched healthy controls. VZV-specific cellular immunity was measured by an interferon gamma (IFNγ) enzyme-linked immunospot (ELISpot) assay and by analyzing T-cell functionality using flowcytometry. VZV-IgG levels were measured using an in-house glycoprotein enzyme-linked immunosorbent assay (gpELISA).

RESULTS

Using paired analysis, it was determined that numbers of IFNγ-producing cells did not change after transplantation, but were significantly lower in transplant recipients after transplantation than in controls (p = 0.028). Patients in whom the post-transplant period was complicated by rejection or any acute infection (excluding HZ) had a lower number of IFNγ-producing cells than patients who did not. VZV IgG levels did not differ from controls, but a significant decrease was observed after transplantation (p < 0.0001).

CONCLUSIONS

VZV-specific cellular immunity, which is essential in the prevention of HZ, did not markedly change in patients following renal transplantation. This suggests that preventive vaccination before transplantation may be beneficial. Our results extend knowledge on VZV immunity after transplantation, vital when considering strategies for the prevention of HZ in these patients.

摘要

背景

带状疱疹（HZ）风险在肾移植受者中很高。移植前接种疫苗可能是预防移植后 HZ 的有用策略。然而，由于移植围手术期的治疗，是否会影响到水痘-带状疱疹病毒（VZV）的免疫尚不清楚。

方法

在 60 名成年肾移植患者和 62 名匹配的健康对照者中，在移植前和移植后 2-3 年，分别测定了针对 VZV 的体液和细胞免疫。使用干扰素γ（IFNγ）酶联免疫斑点（ELISpot）测定法和通过流式细胞术分析 T 细胞功能，测定 VZV 特异性细胞免疫。使用内部糖蛋白酶联免疫吸附测定（gpELISA）测定 VZV-IgG 水平。

结果

通过配对分析，确定移植后 IFNγ产生细胞的数量没有变化，但移植受者的 IFNγ产生细胞数量明显低于对照组（p=0.028）。在移植后发生排斥反应或任何急性感染（不包括 HZ）的患者中，IFNγ产生细胞的数量低于未发生感染的患者。VZV IgG 水平与对照组无差异，但移植后观察到显著下降（p<0.0001）。