Department of Pulmonology, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
Immun Inflamm Dis. 2022 Aug;10(8):e646. doi: 10.1002/iid3.646.
INTRODUCTION: Lung transplant recipients (LuTX) represent a vulnerable population for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Even though many vaccines are already developed, more clinical data need to support effective immunological response in immunocompromised patients. METHODS: Stable LuTX recipients with no medical history of coronavirus disease (COVID-19) were enrolled. Currently available messenger RNA (mRNA) (BNT162b2-mRNA, mRNA-1273) and non-mRNA (ChAdOx1, BBIBP-CorV) vaccines were given according to availability, boosters were all mRNA-based. SARS-CoV-2 Spike1 immunoglobulin G (IgG) antibody titer was evaluated before and 2 weeks after second and third dose. Difference between mRNA versus non-mRNA vaccines was assessed. RESULTS: Forty-one patients (49% men, age 48.4 ± 13.8 years) received two doses of SARS-CoV-2 vaccines: 23 of mRNA, 18 of non-mRNA, and 24/41 (58%) received a third dose. Median 92 months passed since transplantation, and serum level of tacrolimus was median 5.5 ng/ml. Positive serology was found in 37% of all patients after the second dose, 86% had mRNA vaccine. After the third dose, 29% became positive who had no antibody before. Significantly higher level of antibody was found after the second mRNA than non-mRNA vaccines (2.2 vs. 1568.8 U/ml, respectively, p = .002). 6/23 (26%) patients received two doses of mRNA vaccine developed COVID-19 after the second injection in an average of 178 days, half of them recovered, half of them died in intensive care unit (ICU). 3/6 (50%) patients with two doses mRNA and recovered from COVID-19 had significantly higher level of antibody (average 20847.3 U/ml) than without infection. After the booster vaccine, 1/24 (4%) developed infection. CONCLUSION: Immunosuppression therapy may induce a weaker SARS-CoV-2 response in LuTX recipients; therefore, third dose is a priority in transplanted patients. The highest antibody level was measured recovering from COVID after two doses. Our data confirm that booster mRNA vaccine could increase antibody levels, even if immunization was started with non-mRNA vaccine.
简介：肺移植受者（LuTX）是严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）的高危人群。尽管已经开发出许多疫苗，但仍需要更多的临床数据来支持免疫功能低下患者的有效免疫反应。
方法：招募无冠状病毒病（COVID-19）病史的稳定 LuTX 受者。根据可用性，给予目前可用的信使 RNA（mRNA）（BNT162b2-mRNA、mRNA-1273）和非 mRNA（ChAdOx1、BBIBP-CorV）疫苗，所有加强针均为 mRNA 疫苗。在第二剂和第三剂后两周评估 SARS-CoV-2 Spike1 免疫球蛋白 G（IgG）抗体滴度。评估 mRNA 疫苗与非 mRNA 疫苗之间的差异。
结果：41 名患者（49%为男性，年龄 48.4±13.8 岁）接受了两剂 SARS-CoV-2 疫苗：23 名接受 mRNA 疫苗，18 名接受非 mRNA 疫苗，24/41（58%）接受了第三剂。自移植以来中位数 92 个月，血清他克莫司浓度中位数为 5.5ng/ml。第二剂后所有患者中有 37%呈阳性，86%为 mRNA 疫苗。第三剂后，29%的无抗体者转为阳性。第二剂后，mRNA 疫苗的抗体水平明显高于非 mRNA 疫苗（分别为 2.2 和 1568.8U/ml，p=0.002）。23 名接受两剂 mRNA 疫苗的患者中有 6 名（26%）在第二次注射后平均 178 天内发生 COVID-19，其中一半患者康复，一半患者在重症监护病房（ICU）死亡。6 名（50%）接受两剂 mRNA 疫苗并从 COVID-19 中康复的患者的抗体水平明显高于未感染的患者（平均 20847.3U/ml）。加强疫苗接种后，24 名患者中有 1 名（4%）发生感染。
结论：免疫抑制治疗可能会导致 LuTX 受者对 SARS-CoV-2 的反应较弱；因此，第三剂是移植患者的优先事项。从 COVID 中恢复后的最高抗体水平是在接受两剂后测量的。我们的数据证实，加强型 mRNA 疫苗可以提高抗体水平，即使免疫接种是从非 mRNA 疫苗开始的。
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