Burack Daniel, Pereira Marcus R, Tsapepas Demetra S, Harren Patricia, Farr Maryjane A, Arcasoy Selim, Cohen David J, Mohan Sumit, Emond Jean C, Hod Eldad A, Verna Elizabeth C
Department of Medicine, Columbia University College of Physicians & Surgeons, New York, New York.
Department of Medicine, Division of Infectious Disease, Columbia University College of Physicians & Surgeons, New York, New York.
Am J Transplant. 2021 Jun;21(6):2254-2261. doi: 10.1111/ajt.16541. Epub 2021 May 6.
It remains uncertain whether immunocompromised patients including solid organ transplant (SOT) recipients will have a robust antibody response to SARS-CoV-2 infection. We enrolled all adult SOT recipients at our center with confirmed SARS-CoV-2 infection who underwent antibody testing with a single commercially available anti-nucleocapsid antibody test at least 7 days after diagnosis in a retrospective cohort. Seventy SOT recipients were studied (56% kidney, 19% lung, 14% liver ± kidney, and 11% heart ± kidney recipients). Thirty-six (51%) had positive anti-nucleocapsid antibody testing, and 34 (49%) were negative. Recipients of a kidney allograft were less likely to have positive antibody testing compared to those who did not receive a kidney (p = .04). In the final multivariable model, the years from transplant to diagnosis (OR 1.26, p = .002) and baseline immunosuppression with more than two agents (OR 0.26, p = .03) were significantly associated with the antibody test result, controlling for kidney transplantation. In conclusion, among SOT recipients with confirmed infection, only 51% of patients had detectable anti-nucleocapsid antibodies, and transplant-related variables including the level and nature of immunosuppression were important predictors. These findings raise the concern that SOT recipients with COVID-19 may be less likely to form SARS-CoV-2 antibodies.
包括实体器官移植（SOT）受者在内的免疫功能低下患者对SARS-CoV-2感染是否会产生强烈的抗体反应仍不确定。我们在一项回顾性队列研究中纳入了本中心所有确诊感染SARS-CoV-2且在诊断后至少7天接受了单次市售抗核衣壳抗体检测的成年SOT受者。共研究了70名SOT受者（56%为肾移植受者，19%为肺移植受者，14%为肝±肾移植受者，11%为心±肾移植受者）。36名（51%）抗核衣壳抗体检测呈阳性，34名（49%）呈阴性。与未接受肾移植的受者相比，肾移植受者抗体检测呈阳性的可能性较小（p = 0.04）。在最终的多变量模型中，从移植到诊断的年限（比值比1.26，p = 0.002）和使用两种以上药物的基线免疫抑制（比值比0.26，p = 0.03）与抗体检测结果显著相关，同时控制了肾移植因素。总之，在确诊感染的SOT受者中，只有51%的患者可检测到抗核衣壳抗体，包括免疫抑制水平和性质在内的与移植相关的变量是重要的预测因素。这些发现引发了人们对COVID-19的SOT受者可能较难形成SARS-CoV-2抗体的担忧。
