在肾移植受者中，免疫抑制的暂时减少可增强针对严重急性呼吸综合征冠状病毒 2 的抗-S 抗体的产生。
Temporary reduction of immunosuppression enhances production of anti-S antibody against severe acute respiratory syndrome coronavirus 2 after vaccination in kidney transplant recipients.
机构信息
Department of Renal Transplant Surgery and Urology, Sapporo Hokuyu Hospital, Sapporo, Japan.
Transplant Supporting Office, Sapporo Hokuyu Hospital, Sapporo, Japan.
出版信息
Int J Urol. 2022 Dec;29(12):1505-1510. doi: 10.1111/iju.15027. Epub 2022 Sep 7.
OBJECTIVES
The study identified factors affecting anti-S immunoglobulin G production after vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in kidney transplant recipients.
METHODS
Serum samples were prospectively collected from kidney transplant recipients, live kidney donors, and healthy volunteers 1 month after receiving the second dose of SARS-CoV-2 vaccine, and anti-S immunoglobulin G titers were measured. The mycophenolate mofetil dose was reduced before vaccination in some immunologically low-risk recipients.
RESULTS
A total of 151 kidney transplant recipients, 74 live kidney donors, and 50 healthy volunteers were included. Kidney transplant recipients had significantly lower titers of anti-S immunoglobulin G than donors and healthy volunteers (1377 ± 246, 8310 ± 932, and 9908 ± 1040 AU/ml, respectively). Only 67.3% of kidney transplant recipients, compared to 100% of donors and healthy volunteers, were positive for anti-S immunoglobulin G. Among the kidney transplant recipients, the anti-S titer was higher in younger recipients, those with higher peripheral blood lymphocyte counts and glomerular filtration rates, those without a history of antithymocyte globulin use, and those who had discontinued or received a reduced dose of mycophenolate mofetil. Younger age, higher lymphocyte count, glomerular filtration rate, and mycophenolate reduction were significantly associated with anti-S immunoglobulin G > 1000 AU/ml in nominal logistic regression analysis. There were no rejection episodes after mycophenolate modification in kidney transplant recipients.
CONCLUSIONS
Anti-S immunoglobulin G production after vaccination was attenuated in kidney transplant recipients. Mycophenolate mofetil cessation or reduction is a modifiable means to enhance anti-S immunoglobulin G production in immunosuppressed kidney transplant recipients.
目的
本研究旨在确定影响肾移植受者接种严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）疫苗后抗 SARS-CoV-2 免疫球蛋白 G 产生的因素。
方法
前瞻性收集肾移植受者、活体供肾者和健康志愿者接种 SARS-CoV-2 疫苗后 1 个月的血清样本，并检测抗 SARS-CoV-2 免疫球蛋白 G 滴度。部分免疫低危受者在接种前减少霉酚酸酯剂量。
结果
共纳入 151 例肾移植受者、74 例活体供肾者和 50 例健康志愿者。肾移植受者的抗 SARS-CoV-2 免疫球蛋白 G 滴度明显低于供者和健康志愿者（分别为 1377±246、8310±932 和 9908±1040 AU/ml），且仅 67.3%的肾移植受者抗 SARS-CoV-2 免疫球蛋白 G 阳性，而供者和健康志愿者的阳性率均为 100%。在肾移植受者中，年轻受者、外周血淋巴细胞计数和肾小球滤过率较高、无抗胸腺细胞球蛋白使用史、停用或减少霉酚酸酯剂量的受者抗 SARS-CoV-2 滴度较高。在名义逻辑回归分析中，年龄较小、淋巴细胞计数较高、肾小球滤过率较高和霉酚酸酯减少与抗 SARS-CoV-2 免疫球蛋白 G＞1000 AU/ml 显著相关。肾移植受者霉酚酸酯调整后无排斥反应发生。
结论
肾移植受者接种疫苗后抗 SARS-CoV-2 免疫球蛋白 G 产生减弱。霉酚酸酯停药或减量是增强免疫抑制肾移植受者抗 SARS-CoV-2 免疫球蛋白 G 产生的可调节手段。
Zotero 插件