Phadke Varun K, Scanlon Nicholas, Jordan Stanley C, Rouphael Nadine G
Emory University Vaccine and Treatment Evaluation Unit (VTEU), Division of Infectious Diseases, The Hope Clinic of the Emory Vaccine Center, 500 Irvin Court, Suite 200, Decatur, GA 30030 USA.
The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Emory University, Decatur, GA USA.
Curr Transplant Rep. 2021;8(2):127-139. doi: 10.1007/s40472-021-00322-5. Epub 2021 Mar 4.
Coronavirus disease 2019 (COVID-19) is caused by a complex interplay between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) dynamics and host immune responses. Hosts with altered immunity, including solid organ transplant recipients, may be at increased risk of complications and death due to COVID-19. A synthesis of the available data on immune responses to SARS-CoV-2 infection is needed to inform therapeutic and preventative strategies in this special population.
Few studies have directly compared immune responses to SARS-CoV-2 between transplant recipients and the general population. Like non-transplant patients, transplant recipients mount an exuberant inflammatory response following initial SARS-CoV2 infection, with IL-6 levels correlating with disease severity in some, but not all studies. Transplant recipients display anti-SARS-CoV-2 antibodies and activated B cells in a time frame and magnitude similar to non-transplant patients-limited data suggest these antibodies can be detected within 15 days of symptom onset and may be durable for several months. CD4 and CD8 T lymphopenia, a hallmark of COVID-19, is more profound in transplant recipients, but SARS-CoV-2-reactive T cells can be detected among patients with both mild and severe disease.
The limited available data indicate that immune responses to SARS-CoV-2 are similar between transplant recipients and the general population, but no studies have been sufficiently comprehensive to understand nuances between organ types or level of immunosuppression to meaningfully inform individualized therapeutic decisions. The ongoing pandemic provides an opportunity to generate higher-quality data to support rational treatment and vaccination strategies in this population.
2019冠状病毒病（COVID-19）是由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）动态变化与宿主免疫反应之间的复杂相互作用引起的。包括实体器官移植受者在内的免疫功能改变的宿主，可能因COVID-19而出现并发症和死亡的风险增加。需要综合有关对SARS-CoV-2感染免疫反应的现有数据，为这一特殊人群的治疗和预防策略提供依据。
很少有研究直接比较移植受者和普通人群对SARS-CoV-2的免疫反应。与非移植患者一样，移植受者在初次感染SARS-CoV-2后会产生旺盛的炎症反应，在一些但并非所有研究中，白细胞介素-6水平与疾病严重程度相关。移植受者产生抗SARS-CoV-2抗体和激活B细胞的时间框架和程度与非移植患者相似——有限的数据表明，这些抗体在症状出现后15天内即可检测到，并且可能持续数月。CD4和CD8淋巴细胞减少是COVID-19的一个标志，在移植受者中更为严重，但在轻症和重症患者中均可检测到SARS-CoV-2反应性T细胞。
有限的现有数据表明，移植受者和普通人群对SARS-CoV-2的免疫反应相似，但尚无研究足够全面，无法了解不同器官类型或免疫抑制水平之间的细微差别，从而无法为个体化治疗决策提供有意义的信息。当前的大流行提供了一个机会，可以生成更高质量的数据，以支持该人群的合理治疗和疫苗接种策略。
