Vnučák Matej, Graňák Karol, Beliančinová Monika, Jeseňák Miloš, Macháleková Katarína Kajová, Benko Jakub, Samoš Matej, Dedinská Ivana
Transplantation Centre, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Martin, Slovakia.
Department of Children and Adolescents, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Martin, Slovakia.
NPJ Vaccines. 2022 Mar 2;7(1):30. doi: 10.1038/s41541-022-00445-5.
COVID-19 infection remains a threat to the health systems of many countries. Potential success in the fight against the COVID-19 pandemic is the vaccination of high-risk groups, including patients with end-stage kidney disease (ESKD) and after solid organ transplantation (SOT). Immunosuppression in kidney transplant recipients can also reduce the immunogenicity of SARS-CoV-2 vaccines (varied by vaccine platform), available data suggest that they are efficacious in approximately 50-70%, compared to non-transplant situations. In this paper, we present a newly developed acute humoral and cellular rejection with acute allograft failure and need of hemodialysis 14 days after administration of the adenovirus vectored SARS-CoV-2 vaccine (AstraZeneca; CHADOx1, AZD1222). This occurred in a patient who previously had an asymptomatic COVID-19 infection. Case reports of acute allograft rejection after vaccination against SARS-CoV-2 can help stratify risk groups of patients who develop hyperimmune reactions. However, it is also possible that those with a previous mild primary COVID-19 infection may also develop acute allograft rejections upon COVID-19 re-infection.
新冠病毒感染仍然对许多国家的卫生系统构成威胁。抗击新冠疫情取得潜在成功的关键在于为包括终末期肾病（ESKD）患者和实体器官移植（SOT）后患者在内的高危人群接种疫苗。肾移植受者的免疫抑制也可能降低新冠病毒疫苗的免疫原性（因疫苗平台而异），现有数据表明，与非移植情况相比，这些疫苗在肾移植受者中的有效率约为50%至70%。在本文中，我们报告了一例在接种腺病毒载体新冠病毒疫苗（阿斯利康；CHADOx1，AZD1222）14天后出现的新型急性体液和细胞排斥反应，伴有急性移植肾失功并需要进行血液透析的病例。该病例发生在一名既往曾有无症状新冠病毒感染的患者身上。接种新冠病毒疫苗后发生急性移植肾排斥反应的病例报告有助于对发生超敏反应的患者风险群体进行分层。然而，既往曾有轻度新冠病毒初次感染的患者在再次感染新冠病毒时也有可能发生急性移植肾排斥反应。
