Windpessl Martin, Heine Gunnar H, Becker Sören L, Scheuer Anja L, Sester Martina, Kronbichler Andreas
Innere Medizin IV, Klinikum Wels-Grieskirchen, Wels, Österreich.
Medizinische Fakultät, Kepler-Universitätsklinikum, Linz, Österreich.
Dtsch Med Wochenschr. 2021 Oct;146(19):1277-1282. doi: 10.1055/a-1550-7288. Epub 2021 Sep 22.
HOW EFFECTIVE ARE THE APPROVED VACCINES IN KIDNEY DISEASES AND THOSE RECEIVING IMMUNOSUPPRESSION?: Several observational studies indicated that immunosuppression is associated with a weakened or absent humoral response. Patients with chronic kidney diseases or undergoing maintenance dialysis without immunosuppression have a reduced humoral response to COVID-19 vaccines. I HAD COVID-19. SHOULD I GET VACCINATED?: It is recommended to receive a booster after SARS-CoV-2 infection with a mRNA vaccine. IS A COVID-19 VACCINATION DESPITE ONGOING IMMUNOSUPPRESSION POSSIBLE?: Patients receiving immunosuppression have a reduced humoral response, and this is especially observed when anti-CD20 therapy is used. IS THERE A POSSIBILITY THAT THE VACCINE PROVOKES REJECTION OF MY TRANSPLANTED KIDNEY OR RELAPSE OF MY GLOMERULAR DISEASE?: Several reports were published in the last months highlighting new-onset diseases, recurrences and relapses of different glomerular diseases, which occurred after the receipt of the first or second vaccine dose. As a clear association of vaccines and induction of autoimmunity still needs to be established, most of these diseases are treatable, and COVID-19 in patients under immunosuppression is often fatal, there is a clear net benefit of vaccination. DO I HAVE A PERMANENT PROTECTION AFTER VACCINATION?: The antibody titers and likely the cellular immune response is significantly reduced in patients with kidney diseases, and titers are reducing at a fast pace under ongoing immunosuppression. A booster dose should be considered, especially taking into consideration the evolvement of virus variants and their impact on vaccine efficacy. AFTER THE FIRST SERIES OF VACCINATION, NO OR ONLY A MARGINAL AMOUNT OF ANTIBODIES WERE DETECTABLE. ARE THERE STRATEGIES TO IMPROVE VACCINE RESPONSE?: Many countries recommend the application of a third dose for vulnerable patient cohorts, especially because of a weakened response and their risk to develop a severe disease course of COVID-19. Prospective clinical trials are ongoing to test the ideal strategy to improve vaccine response in these cohorts.
获批的疫苗对肾脏疾病患者及接受免疫抑制治疗的患者效果如何？：多项观察性研究表明，免疫抑制与体液反应减弱或缺失有关。慢性肾脏病患者或接受维持性透析且未接受免疫抑制治疗的患者对新冠疫苗的体液反应降低。
我感染过新冠病毒，还需要接种疫苗吗？：建议在感染新冠病毒后用mRNA疫苗接种加强针。
正在接受免疫抑制治疗的患者可以接种新冠疫苗吗？：接受免疫抑制治疗的患者体液反应降低，使用抗CD20疗法时尤其如此。
疫苗会引发移植肾排斥反应或肾小球疾病复发吗？：过去几个月发表了多篇报告，强调在接种第一剂或第二剂疫苗后出现了不同肾小球疾病的新发疾病、复发和病情加重情况。由于疫苗与自身免疫诱导之间的明确关联仍有待确定，且这些疾病大多是可治疗的，而免疫抑制患者感染新冠病毒往往是致命的，因此接种疫苗有明显的净益处。
接种疫苗后我能获得永久保护吗？：肾病患者的抗体滴度以及可能的细胞免疫反应显著降低，在持续免疫抑制的情况下滴度迅速下降。应考虑接种加强针，尤其是考虑到病毒变体的演变及其对疫苗效力的影响。
接种第一剂疫苗后未检测到抗体或仅检测到少量抗体。有提高疫苗反应的策略吗？：许多国家建议为脆弱患者群体接种第三剂疫苗，特别是因为他们反应较弱且有患新冠重症病程的风险。正在进行前瞻性临床试验以测试改善这些群体疫苗反应的理想策略。
