成人实体器官移植受者对 SARS-CoV-2 疫苗弱抗体反应的危险因素：系统评价和荟萃分析。

Risk Factors for Weak Antibody Response of SARS-CoV-2 Vaccine in Adult Solid Organ Transplant Recipients: A Systemic Review and Meta-Analysis.

机构信息

Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

出版信息

Front Immunol. 2022 Jun 14;13:888385. doi: 10.3389/fimmu.2022.888385. eCollection 2022.

OBJECTIVE

This is the first systematic review and meta-analysis to determine the factors that contribute to poor antibody response in organ transplant recipients after receiving the 2-dose severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine.

METHOD

Data was obtained from Embase, PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Chinese Biomedical Literature Database (CBM). Studies reporting factors associated with antibody responses to the 2-dose SARS-CoV-2 vaccine in solid organ transplant recipients were included in our study based on the inclusion and exclusion criteria. Two researchers completed the literature search, screening, and data extraction. Randomized models were used to obtain results. Egger's test was performed to determine publication bias. Sensitivity analysis was performed to determine the stability of the result. The heterogeneity was determined using the Galbraith plot and subgroup analysis.

RESULTS

A total of 29 studies were included in the present study. The factors included living donor, BNT162b2, tacrolimus, cyclosporine, antimetabolite, mycophenolic acid (MPA) or mycophenolate mofetil (MMF), azathioprine, corticosteroids, high-dose corticosteroids, belatacept, mammalian target of rapamycin (mTOR) inhibitor, tritherapy, age, estimated glomerular filtration rate (eGFR), hemoglobin, and tacrolimus level were significantly different. Multivariate analysis showed significant differences in age, diabetes mellitus, MPA or MMF, high-dose corticosteroids, tritherapy, and eGFR.

CONCLUSION

The possible independent risk factors for negative antibody response in patients with organ transplants who received the 2-dose SARS-CoV-2 vaccine include age, diabetes mellitus, low eGFR, MPA or MMF, high-dose corticosteroids, and triple immunosuppression therapy. mTOR inhibitor can be a protective factor against weak antibody response.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO, identifier CRD42021257965.

目的

这是第一项旨在确定接受 2 剂严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）疫苗后器官移植受者抗体反应不良的相关因素的系统评价和荟萃分析。

方法

数据来自 Embase、PubMed、Web of Science、Cochrane 图书馆、中国国家知识基础设施（CNKI）和中国生物医学文献数据库（CBM）。根据纳入和排除标准，我们的研究纳入了报告与器官移植受者对 2 剂 SARS-CoV-2 疫苗的抗体反应相关因素的研究。两位研究人员完成了文献检索、筛选和数据提取。使用随机模型获取结果。采用 Egger 检验确定发表偏倚。进行敏感性分析以确定结果的稳定性。使用 Galbraith 图和亚组分析确定异质性。

结果

本研究共纳入 29 项研究。这些因素包括活体供者、BNT162b2、他克莫司、环孢素、代谢抑制剂、霉酚酸（MPA）或霉酚酸酯（MMF）、硫唑嘌呤、皮质类固醇、大剂量皮质类固醇、巴利昔单抗、雷帕霉素（mTOR）抑制剂、三联疗法、年龄、估计肾小球滤过率（eGFR）、血红蛋白和他克莫司水平。多变量分析显示，年龄、糖尿病、MPA 或 MMF、大剂量皮质类固醇、三联疗法和 eGFR 差异有统计学意义。