肝移植受者接种第三剂抗 SARS-CoV-2 BNT16b2 疫苗的免疫原性和安全性。
Immunogenicity and safety of a third dose of anti-SARS-CoV-2 BNT16b2 vaccine in liver transplant recipients.
机构信息
Hepatology and Liver Transplantation Unit, Department of Specialized Medicine, Udine University Hospital, Udine, Italy.
Clinical Pathology, Udine University Hospital, Udine, Italy.
出版信息
Liver Int. 2023 Feb;43(2):452-461. doi: 10.1111/liv.15331. Epub 2022 Dec 14.
BACKGROUND & AIMS: A strategy to improve the low rate of anti-SARS-CoV-2 mRNA vaccine-induced immunogenicity in liver transplant recipients (LTs) is urgently needed.
METHODS
We analysed the rate of positive (≥0.8 U/ml) anti-SARS-CoV-2 receptor domain-binding protein (RBD) antibody response 2 months after a third dose of the BNT16b2 vaccine in 107 LTs who completed the second vaccine dose 7 months earlier.
RESULTS
A positive anti-SARS-CoV-2-s-RBD antibody response after the third vaccine dose was detected in 98 (91.6%) LTs compared to 82 (76.6%) after the second vaccine dose (p = .003). The median of anti-SARS-CoV-2 RBD antibody titres increased from 22.9 U/ml 6 months after the second to 3500 U/ml 2 months after the third vaccine dose (p < .001). Fourteen (14.3%) responder patients presented antibody titres <100 U/ml, 57 (58.2%) between 100 and 9999 U/ml and 27 (27.6%) ≥10 000 U/ml. Seropositivity after the second dose was maintained after the third dose. Independent predictors of antibody response failure after the third vaccine dose were taking a higher daily dose of mycophenolate mofetil (MMF, p < .001) and had a lower (<60 ml/min/1.73 m ) estimated glomerular filtration rate (p = .007). Nine (9.1%) LTs experienced symptomatic SARS-CoV-2 infection after the third vaccine dose. Median antibody titres were not statistically different between infected and not infected LTs (1325 vs 3515 U/ml, p = .678).
CONCLUSIONS
The third dose of the BNT16b2 vaccine increased the number of LTs who developed a positive anti-SARS-CoV-2 s-RBD antibody response. A proportion of patients remained unresponsive, mainly for modifiable factors, such as the use of MMF or multiple immunosuppressants.
背景与目的
急需制定策略来提高肝移植受者（LT）中抗 SARS-CoV-2 mRNA 疫苗免疫原性的低应答率。
方法
我们分析了 107 例 LT 在完成第二剂疫苗接种 7 个月后，接种第三剂 BNT16b2 疫苗 2 个月后抗 SARS-CoV-2 受体结构域结合蛋白（RBD）抗体的阳性（≥0.8 U/ml）应答率。
结果
与第二剂疫苗接种后相比，第三剂疫苗接种后有 98 例（91.6%）LT 检测到抗 SARS-CoV-2-s-RBD 抗体阳性应答，而有 82 例（76.6%）（p = 0.003）。第二剂疫苗接种后 6 个月，抗 SARS-CoV-2 RBD 抗体滴度中位数从 22.9 U/ml 增加到第三剂疫苗接种后 2 个月的 3500 U/ml（p < 0.001）。14 例（14.3%）应答者的抗体滴度<100 U/ml，57 例（58.2%）为 100~9999 U/ml，27 例（27.6%）≥10 000 U/ml。第三剂疫苗接种后，第二剂疫苗接种后的血清阳性率得以维持。第三剂疫苗接种后抗体应答失败的独立预测因素是服用更高剂量的吗替麦考酚酯（MMF，p < 0.001）和估计肾小球滤过率（eGFR）较低（<60 ml/min/1.73 m）（p = 0.007）。9 例（9.1%）LT 在接种第三剂疫苗后出现有症状的 SARS-CoV-2 感染。感染和未感染 LT 之间的抗体滴度中位数无统计学差异（1325 与 3515 U/ml，p = 0.678）。
结论
第三剂 BNT16b2 疫苗增加了产生抗 SARS-CoV-2 s-RBD 抗体阳性应答的 LT 数量。由于可改变的因素（如使用 MMF 或多种免疫抑制剂），仍有一部分患者对疫苗无反应。
Zotero 插件