Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
Transplant Proc. 2022 Jul-Aug;54(6):1517-1523. doi: 10.1016/j.transproceed.2022.05.030. Epub 2022 Jun 15.
There are limited data regarding the clinical efficacy of COVID-19 vaccines among lung transplant (LT) patients.
We included all LT patients diagnosed with COVID-19 between March 1, 2020, and December 10, 2021 (n = 84; median age 55, range, 20-73 years; males 65.5%). The study group was divided into 3 groups based on the vaccination status (patients who did not complete the primary series for any of the vaccines: n = 58; those with 2 doses of messenger RNA (mRNA) or 1 dose of the adenoviral vector vaccine, vaccinated group: n = 16; those with at least 1 additional dose beyond the primary series, boosted group: n = 10).
Pulmonary parenchymal involvement on chest computed tomography scan was less common among the boosted group (P = .009). The proportion of patients with new or worsening respiratory failure was significantly lower among the vaccinated and boosted groups and these patients were significantly more likely to achieve the composite endpoint of oxygen-dependence free survival (P = .02). On multivariate logistic regression analysis, higher body mass index, restrictive lung disease as the transplant indication, and preinfection chronic lung allograft dysfunction were independently associated with acute or acute on chronic respiratory failure while being on therapeutic dose anticoagulation and having received the booster dose had a protective effect.
COVID-19 vaccines appear to have several favorable effects among LT patients with breakthrough infections including lower likelihood of allograft involvement on imaging (among boosted patients), need of hospitalization, and complications such as new or worsening respiratory failure.
关于 COVID-19 疫苗在肺移植（LT）患者中的临床疗效的数据有限。
我们纳入了 2020 年 3 月 1 日至 2021 年 12 月 10 日期间诊断为 COVID-19 的所有 LT 患者（n=84；中位年龄 55 岁，范围 20-73 岁；男性 65.5%）。根据疫苗接种状态，将研究组分为 3 组（未完成任何疫苗的基础系列接种的患者：n=58；接种了 2 剂信使 RNA（mRNA）或 1 剂腺病毒载体疫苗的患者：n=16；至少接受了基础系列之外的 1 剂加强剂的患者：n=10）。
胸部计算机断层扫描（CT）扫描中肺实质受累在加强组中较少见（P=0.009）。在接种疫苗和加强组中，新发或加重呼吸衰竭的患者比例显著较低，这些患者更有可能达到无吸氧依赖生存的复合终点（P=0.02）。在多变量逻辑回归分析中，较高的体重指数、作为移植指征的限制性肺疾病和感染前慢性肺移植物功能障碍与急性或慢性呼吸衰竭有关，而接受治疗剂量抗凝和加强剂量则具有保护作用。
COVID-19 疫苗似乎对突破感染的 LT 患者有多种有利影响，包括影像学上供体肺受累的可能性降低（在加强组中）、住院需求以及新发或加重呼吸衰竭等并发症的减少。
