Akyol Merve, Çevik Enes, Ucku Duygu, Tanrıöver Cem, Afşar Barış, Kanbay Asiye, Covic Adrian, Ortiz Alberto, Basile Carlo, Kanbay Mehmet
Department of Internal Diseases, Koc University School of Medicine, İstanbul, Turkey.
Division of Nephrology, Department of Internal Diseases, Suleyman Demirel University School of Medicine, Isparta,Turkey.
Tuberk Toraks. 2021 Dec;69(4):547-560. doi: 10.5578/tt.20219612.
Kidney transplant recipients and dialysis patients constitute a risk group for severe COVID-19. They are highly advised to get vaccinated according to the current guidelines. However, data on antibody response, cell responses and protection from events, and factors that might alter this response after a routine full series of vaccination remain incomplete for these populations. The aim of this article was to analyze the antibody responses after a full series of mRNA-based SARS-CoV-2 vaccination in kidney transplantation and dialysis patients and to define the factors that alter seroconversion status in these populations. In this systematic review, 18 studies investigating the antibody response to full vaccination with two doses of COVID-19 mRNA vaccines in hemodialysis, peritoneal dialysis, and kidney transplant patients were included. Kidney transplant and dialysis patients have a lower seroconversion rate after mRNA-based SARS-CoV-2 vaccination than the healthy population: 27.2% for kidney transplantation, 88.5% for dialysis patients while all healthy control in these studies seroconverted. Moreover, anti-S antibody titers were lower in seroconverted kidney transplantation or dialysis patients than in healthy control in all studies that assessed this variable. Older age and dialysis vintage, immunosuppressive or chemotherapy treatment, and lower serum albumin, white blood cell, lymphocyte and hemoglobin counts were associated with lower/no antibody response to vaccination. Dialysis patients and kidney transplant recipients have lower seroconversion rates after a full series of mRNA-based SARS-CoV-2 vaccination than the general population. Several factors are associated with an altered antibody response. A third dose could be considered in this patient group.
肾移植受者和透析患者是感染重症 COVID-19 的风险群体。强烈建议他们按照现行指南接种疫苗。然而,对于这些人群,关于抗体反应、细胞反应、预防感染情况以及常规全程接种疫苗后可能改变这种反应的因素的数据仍然不完整。本文的目的是分析肾移植和透析患者在全程接种基于 mRNA 的 SARS-CoV-2 疫苗后的抗体反应,并确定这些人群中改变血清转化状态的因素。在这项系统评价中,纳入了 18 项研究,这些研究调查了血液透析、腹膜透析和肾移植患者对两剂 COVID-19 mRNA 疫苗全程接种的抗体反应。肾移植和透析患者在接种基于 mRNA 的 SARS-CoV-2 疫苗后的血清转化率低于健康人群:肾移植患者为 27.2%,透析患者为 88.5%,而这些研究中的所有健康对照者均发生了血清转化。此外,在所有评估该变量的研究中,血清转化的肾移植或透析患者的抗 S 抗体滴度均低于健康对照者。年龄较大、透析时间较长、免疫抑制或化疗治疗以及血清白蛋白、白细胞、淋巴细胞和血红蛋白计数较低与疫苗接种后的抗体反应较低/无抗体反应相关。透析患者和肾移植受者在全程接种基于 mRNA 的 SARS-CoV-2 疫苗后的血清转化率低于普通人群。几个因素与抗体反应改变有关。可以考虑为该患者群体接种第三剂疫苗。