Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.
Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Transplantation. 2022 Aug 1;106(8):1622-1628. doi: 10.1097/TP.0000000000004178. Epub 2022 May 3.
Solid organ transplant (SOT) recipients are at high risk for complications from coronavirus disease 2019 (COVID-19). Vaccination may mitigate this risk; however, immunogenicity appears to be significantly impaired, with reports of increased risk of breakthrough infection. It is unknown if vaccine breakthrough infections are milder or as severe as infections in unvaccinated patients.
We performed a multicenter matched cohort study between March 2020 and September 2021 to assess influence of COVID-19 vaccination on outcomes of COVID-19 infection. Treatment characteristics and disease severity outcomes were compared on the basis of vaccine status; breakthrough infections versus unvaccinated infections. Variable ratio propensity score matching based on age, sex, transplant type, and number of comorbidities, was used to develop the analytic cohort. Logistic regression was used to assess the influence of vaccination status on the selected outcomes.
From a cohort of 511 SOT patients with COVID-19, we matched 77 partially or fully vaccinated patients with 220 unvaccinated patients. Treatment characteristics including use of dexamethasone, remdesivir, and antibiotics did not differ. Vaccinated participants were more likely to receive tocilizumab, 15 of 77 (19.5%) versus 5 of 220 (2.3%), P < 0.001. Disease severity outcomes including oxygen requirement, mechanical ventilation, and mortality were similar among medically attended vaccine breakthroughs compared with unvaccinated patients.
SOT recipients who develop medically attended COVID-19 following 1- or 2-dose vaccination seem to have similar disease severity to unvaccinated patients who develop infection. This is consistent with the requirement that SOT recipients need 3 or more vaccine doses and emphasizes the importance of alternate strategies for this population.
实体器官移植 (SOT) 受者罹患 2019 年冠状病毒病 (COVID-19) 并发症的风险很高。疫苗接种可能会降低这种风险；然而，免疫原性似乎明显受损，有报告称突破性感染的风险增加。尚不清楚疫苗突破性感染是否比未接种疫苗的患者的感染更轻微或更严重。
我们进行了一项多中心匹配队列研究，时间为 2020 年 3 月至 2021 年 9 月，以评估 COVID-19 疫苗接种对 COVID-19 感染结局的影响。根据疫苗接种状态；突破性感染与未接种感染比较治疗特征和疾病严重程度结局。基于年龄、性别、移植类型和合并症数量，采用变量比例倾向评分匹配来建立分析队列。采用逻辑回归评估疫苗接种状态对选定结局的影响。
从 511 例 SOT 合并 COVID-19 患者中，我们匹配了 77 例部分或完全接种疫苗和 220 例未接种疫苗的患者。包括使用地塞米松、瑞德西韦和抗生素在内的治疗特征没有差异。接种疫苗的参与者更有可能接受托珠单抗，77 例中有 15 例 (19.5%)，而 220 例中只有 5 例 (2.3%)，P < 0.001。在接受医疗护理的疫苗突破性感染患者中，与未接种疫苗的患者相比，疾病严重程度结局，包括氧需求、机械通气和死亡率相似。
接受 1 剂或 2 剂疫苗接种后出现有医疗护理的 COVID-19 的 SOT 受者，其疾病严重程度似乎与未接种疫苗的感染者相似。这与 SOT 受者需要接种 3 剂或更多疫苗的要求一致，并强调了这一人群需要替代策略的重要性。
