Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.
Erasmus MC Transplant Institute, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.
Transplantation. 2022 Oct 1;106(10):2068-2075. doi: 10.1097/TP.0000000000004256. Epub 2022 Jun 28.
The rapid development and universal access to vaccines represent a milestone in combating the coronavirus disease 2019 (COVID-19) pandemic. However, there are major concerns about vaccine response in immunocompromised populations in particular transplant recipients. In the present study, we aim to comprehensively assess the humoral response to COVID-19 vaccination in both orthotopic organ transplant and allogeneic hematopoietic stem cell transplant recipients.
We performed a systematic review and meta-analysis of 96 studies that met inclusion criteria.
The pooled rates of seroconversion were 49% (95% confidence interval [CI], 43%-55%) in transplant recipients and 99% (95% CI, 99%-99%) in healthy controls after the second dose of vaccine. The pooled rate was 56% (95% CI, 49%-63%) in transplant recipients after the third dose. Immunosuppressive medication is the most prominent risk factor associated with seroconversion failure, but different immunosuppressive regimens are associated with differential outcomes in this respect. Calcineurin inhibitors, steroids, or mycophenolate mofetil/mycophenolic acid are associated with an increased risk of seroconversion failure, whereas azathioprine or mammalian target of rapamycin inhibitors do not. Advanced age, short interval from receiving the vaccine to the time of transplantation, or comorbidities confers a higher risk for seroconversion failure.
Transplant recipients compared with the general population have much lower rates of seroconversion upon receiving COVID-19 vaccines. Immunosuppressants are the most prominent factors associated with seroconversion, although different types may have differential effects.
疫苗的快速发展和广泛应用是抗击 2019 年冠状病毒病（COVID-19）大流行的一个里程碑。然而，人们尤其对免疫功能低下人群（特别是移植受者）的疫苗反应存在重大担忧。在本研究中，我们旨在全面评估原位器官移植和异基因造血干细胞移植受者接种 COVID-19 疫苗后的体液免疫反应。
我们对符合纳入标准的 96 项研究进行了系统评价和荟萃分析。
在接受第二剂疫苗后，移植受者的血清转化率为 49%（95%置信区间[CI]，43%-55%），健康对照者为 99%（95%CI，99%-99%）。移植受者在接受第三剂疫苗后血清转化率为 56%（95%CI，49%-63%）。免疫抑制药物是与血清转化率失败相关的最显著危险因素，但不同的免疫抑制方案在这方面具有不同的结果。钙调神经磷酸酶抑制剂、类固醇或霉酚酸酯/霉酚酸与血清转化率失败的风险增加相关，而硫唑嘌呤或哺乳动物雷帕霉素抑制剂则不然。高龄、从接种疫苗到移植的时间间隔较短或合并症与血清转化率失败的风险较高相关。
与一般人群相比，移植受者在接种 COVID-19 疫苗后血清转化率较低。免疫抑制剂是与血清转化率相关的最显著因素，但不同类型的免疫抑制剂可能具有不同的影响。
