Altheaby Abdulrahman, Alloqmani Duha, AlShammari Rawaby, Alsuhaibani Albatoul, Hakeem Anadel, Alam Syed, Alharbi Shroug, Al Zunitan Mohammed, Bosaeed Mohammad, Alharbi Naif K
Department of Hepatobiliary Sciences and Organ Transplant Center, King Abdulaziz Medical City, Riyadh, SAU.
Department of Medicine, King Abdulaziz Medical City, Riyadh, SAU.
Cureus. 2022 May 5;14(5):e24753. doi: 10.7759/cureus.24753. eCollection 2022 May.
Kidney transplant recipients appear to be at high risk for critical coronavirus disease 2019 (COVID-19) illness. They are considered a priority for COVID-19 vaccination. Only a few studies report on the safety and efficacy of the COVID-19 vaccine in these patients.
In this prospective observational study, we measured anti-severe acute respiratory syndrome coronavirus 2 (anti-SARS-CoV-2) spike-specific IgG post first and second COVID-19 mRNA vaccines in 113 kidney transplant recipients and compared them to 62 healthy volunteers.
After the first COVID-19 vaccine, SARS-CoV-2-specific antibodies were undetectable in 38.9% of kidney transplant recipients, and after the second, it remained undetectable in 12.4%. SARS-CoV-2-specific antibodies were significantly lower in kidney transplant recipients. The average antibody titer after the first vaccine was 1243.6±4137.5 in kidney transplant recipients compared to 20012.2±44436.4 in the controls after the first dose (P=0.002), and 7965.5±12431.3 versus 82891.3±67418.7, respectively, after the second dose (P <0.001). The immune response to the COVID-19 vaccine seemed to be influenced by mycophenolate dose in kidney transplant recipients and pre-vaccination infection.
Kidney transplant recipients are prone to have attenuated antibody responses (anti-spike IgGs) to mRNA COVID-19 vaccines. Patients on mycophenolate mofetil (2 gm daily) had significantly lower SARS-CoV-2 spike-specific IgG levels as compared to patients on no or reduced dose of mycophenolate. Hence, kidney transplant recipients need to continue all infection control precautionary measures against COVID-19 infection and should be considered a priority for a third COVID-19 vaccine.
肾移植受者似乎患重症2019冠状病毒病（COVID-19）的风险很高。他们被视为COVID-19疫苗接种的优先对象。只有少数研究报告了COVID-19疫苗在这些患者中的安全性和有效性。
在这项前瞻性观察研究中，我们测量了113名肾移植受者在接种第一剂和第二剂COVID-19 mRNA疫苗后针对严重急性呼吸综合征冠状病毒2（抗SARS-CoV-2）刺突蛋白的特异性IgG，并将其与62名健康志愿者进行比较。
在接种第一剂COVID-19疫苗后，38.9%的肾移植受者中检测不到SARS-CoV-2特异性抗体，接种第二剂后，仍有12.4%检测不到。肾移植受者中SARS-CoV-2特异性抗体明显较低。肾移植受者在接种第一剂疫苗后的平均抗体滴度为1243.6±4137.5，而对照组在接种第一剂后的平均抗体滴度为20012.2±44436.4（P=0.002），接种第二剂后分别为7965.5±12431.3和82891.3±67418.7（P<0.001）。肾移植受者对COVID-19疫苗的免疫反应似乎受霉酚酸剂量和接种前感染的影响。
肾移植受者对mRNA COVID-19疫苗的抗体反应（抗刺突蛋白IgG）容易减弱。与未服用或服用较低剂量霉酚酸的患者相比，服用霉酚酸酯（每日2克）的患者的SARS-CoV-2刺突蛋白特异性IgG水平明显较低。因此，肾移植受者需要继续采取所有针对COVID-19感染的感染控制预防措施，并且应被视为接种第三剂COVID-19疫苗的优先对象。
