Nephrology Department, Sackler Faculty of Medicine, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel.
Organ Transplantation Unit, Sackler Faculty of Medicine, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel.
Am J Transplant. 2021 Aug;21(8):2719-2726. doi: 10.1111/ajt.16615. Epub 2021 May 7.
COVID-19 is associated with increased morbidity and mortality in transplant recipients. There are no efficacy data available regarding these patients with any of the available SARS-CoV-2 vaccines. We analyzed the humoral response following full vaccination with the BNT162b2 (Pfizer-BioNTech) in 136 kidney transplant recipients, and compared it to 25 controls. In order to exclude prior exposure to the virus, only participants with negative serology to SARS-CoV-2 nucleocapsid protein were included. All controls developed a positive response to spike protein, while only 51 of 136 transplant recipients (37.5%) had positive serology (p < .001). Mean IgG anti-spike level was higher in the controls (31.05 [41.8] vs. 200.5 [65.1] AU/mL, study vs. control, respectively, p < .001). Variables associated with null humoral response were older age (odds ratio 1.66 [95% confidence interval 1.17-2.69]), high-dose corticosteroids in the last 12 months (1.3 [1.09-1.86]), maintenance with triple immunosuppression (1.43 [1.06-2.15]), and regimen that includes mycophenolate (1.47 [1.26-2.27]). There was a similar rate of side effects between controls and recipients, and no correlation was found between the presence of symptoms and seroconversion. Our findings suggest that most kidney transplant recipients remain at high risk for COVID-19 despite vaccination. Further studies regarding possible measures to increase recipient's response to vaccination are required.
COVID-19 与移植受者的发病率和死亡率增加有关。对于这些患者，任何现有的 SARS-CoV-2 疫苗都没有疗效数据。我们分析了 136 例肾移植受者接种 BNT162b2（辉瑞-生物科技）后的体液反应，并将其与 25 名对照者进行了比较。为了排除先前接触过病毒，只有 SARS-CoV-2 核衣壳蛋白血清学阴性的参与者才被纳入。所有对照者均对刺突蛋白产生了阳性反应，而只有 136 例移植受者中的 51 例（37.5%）血清学呈阳性（p<.001）。对照组的 IgG 抗刺突蛋白水平较高（分别为 31.05 [41.8] AU/mL 和 200.5 [65.1] AU/mL，p<.001）。与无体液反应相关的变量包括年龄较大（优势比 1.66 [95%置信区间 1.17-2.69]）、过去 12 个月内使用高剂量皮质类固醇（1.3 [1.09-1.86]）、维持三联免疫抑制（1.43 [1.06-2.15]）和包括吗替麦考酚酯的方案（1.47 [1.26-2.27]）。对照组和受者的副作用发生率相似，且症状的出现与血清转化之间无相关性。我们的研究结果表明，尽管进行了疫苗接种，大多数肾移植受者仍面临 COVID-19 的高风险。需要进一步研究可能增加受者对疫苗反应的措施。
