Cardiff Transplant Unit, University Hospital of Wales, Cardiff, United Kingdom.
Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom.
Transplantation. 2022 Jul 1;106(7):1421-1429. doi: 10.1097/TP.0000000000004105. Epub 2022 Mar 8.
Severe acute respiratory syndrome coronavirus 2 is associated with high mortality among transplant recipients. Comparative data that define humoral responses to the Oxford-AstraZeneca (AZ) and BNT162b2 (Pfizer-BioNTech) vaccines are limited.
We recruited 920 kidney transplant patients receiving at least 1 dose of severe acute respiratory syndrome coronavirus 2 vaccine, excluding patients with virus pre-exposure. Serological status was determined with the COVID-SeroKlir ELISA (Kantaro-EKF Diagnostics). Patients with a corrected antibody level of <0.7 AU/mL were considered seronegative.
Four hundred ninety-five AZ and 141 Pfizer patients had a sample analyzed after first dose and 593 after second dose (346 AZ versus 247 Pfizer). After first dose, 25.7% of patients seroconverted (26.6% AZ, 22.8% Pfizer). After second dose, 148 (42.8%) of AZ seroconverted compared with 130 (52.6%) of Pfizer (P = 0.02; hazard ratio, 1.48; 95% confidence interval, 1.07-2.06). When negative responders were excluded, Pfizer patients were shown to have significantly higher response than AZ patients (median 2.6 versus 1.78 AU/mL, P = 0.005).Patients on mycophenolate had a reduced seroconversion rate (42.2% versus 61.4%; P < 0.001; hazard ratio, 2.17) and reduced antibody levels (0.47 versus 1.22 AU/mL, P = 0.001), and this effect was dose dependent (P = 0.05). Prednisolone reduced the seroconversion from 58.2% to 43.6% (P = 0.03) among Pfizer but not AZ recipients. Regression analysis showed that antibody levels were reduced by older age (P = 0.002), mycophenolate (P < 0.001), AZ vaccine (versus Pfizer, P = 0.001), and male gender (P = 0.02). Sixteen of 17 serious postvaccine infections occurred to patients who did not seroconvert.
Both seroconversion and antibody levels are lower in AZ compared with Pfizer vaccinated recipients following 2 vaccine doses. Mycophenolate was associated with lower antibody responses in a dose-dependent manner. Serious postvaccine infections occurred among seronegative recipients.
严重急性呼吸综合征冠状病毒 2 与移植受者的高死亡率有关。将牛津-阿斯利康（AZ）和 BNT162b2（辉瑞-生物技术）疫苗的体液反应定义进行比较的数据有限。
我们招募了 920 名接受至少 1 剂严重急性呼吸综合征冠状病毒 2 疫苗的肾移植患者，不包括病毒暴露前的患者。使用 COVID-SeroKlir ELISA（Kantaro-EKF Diagnostics）检测血清状态。抗体水平校正<0.7 AU/mL 的患者被认为血清阴性。
495 名 AZ 和 141 名辉瑞患者在第一剂后和 593 名在第二剂后进行了样本分析（266%AZ，22.8%辉瑞）。第一剂后，25.7%的患者发生血清转化（26.6%AZ，22.8%辉瑞）。第二剂后，148 名 AZ 患者（42.8%）发生血清转化，而 130 名辉瑞患者（52.6%）发生血清转化（P=0.02；危险比，1.48；95%置信区间，1.07-2.06）。排除阴性反应者后，辉瑞患者的反应明显高于 AZ 患者（中位数 2.6 与 1.78 AU/mL，P=0.005）。接受吗替麦考酚酯治疗的患者血清转化率较低（42.2%与 61.4%；P<0.001；危险比，2.17）和抗体水平较低（0.47 与 1.22 AU/mL，P=0.001），且这种作用呈剂量依赖性（P=0.05）。泼尼松龙使辉瑞而非 AZ 受者的血清转化率从 58.2%降至 43.6%（P=0.03）。回归分析显示，年龄较大（P=0.002）、吗替麦考酚酯（P<0.001）、AZ 疫苗（与辉瑞相比，P=0.001）和男性（P=0.02）均降低了抗体水平。17 例严重疫苗后感染中有 16 例发生在未发生血清转化的患者中。
与接受辉瑞疫苗接种的患者相比，AZ 接种者在接种 2 剂疫苗后血清转化率和抗体水平均较低。吗替麦考酚酯与剂量依赖性的较低抗体反应相关。严重的疫苗后感染发生在血清阴性的受者中。
