COVID-19 疫苗接种后慢性肾脏病和肾移植患者的免疫反应。

BACKGROUND: Vaccination of patients with chronic kidney disease (CKD) and kidney transplants (KTs) may achieve a less robust immune response. Understanding such immune responses is crucial for guiding current and future vaccine dosing strategies. METHODS: This prospective, observational study estimated the immunogenicity of humoral and cellular responses of two SARS-CoV-2 vaccines in different patient groups with CKD compared with controls. Secondary outcomes included adverse events after vaccination and the incidence of COVID-19 breakthrough infection, including illness severity. RESULTS: In total, 212 patients received ChAdOx1 nCoV-19 (89.62 %) or inactivated vaccines (10.38 %).The antibody response against the S protein was analyzed at T0 (before the first injection), T1 (before the second injection), and T2 (12 weeks after the second injection). Seroconversion occurred in 92.31 % of controls at T2 and in 100 % of patients with CKD, 42.86 % undergoing KT, 80.18 % of hemodialysis (HD), and 0 % of patients undergoing continuous ambulatory peritoneal dialysis (CAPD) at T2 of the ChAdOx1 nCoV-19 vaccine. Neutralizing antibody levels by surrogate virus neutralization test were above the protective level at T2 in each group. The KT group exhibited the lowest neutralizing antibody and T cell response. Blood groups O and vaccine type were associated with good immunological responses. After the first dose, 14 individuals (6.6 out of the total population experienced COVID-19 breakthrough infection. CONCLUSION: Immunity among patients with CKD and HD after vaccination was strong and comparable with that of healthy controls. Our study suggested that a single dose of the vaccine is not efficacious and delays may result in breakthrough infection. Some blood groups and types of vaccine can affect the immune response.

背景：慢性肾脏病（CKD）患者和肾移植（KT）患者接种疫苗可能产生较弱的免疫反应。了解这种免疫反应对于指导当前和未来的疫苗剂量策略至关重要。

方法：这项前瞻性观察性研究估计了与对照组相比，不同 CKD 患者群体中两种 SARS-CoV-2 疫苗的体液和细胞免疫原性。次要结局包括接种后的不良事件以及 COVID-19 突破性感染的发生率，包括疾病严重程度。

结果：共有 212 名患者接受了 ChAdOx1 nCoV-19（89.62%）或灭活疫苗（10.38%）。在 T0（第一次注射前）、T1（第二次注射前）和 T2（第二次注射后 12 周）分析了针对 S 蛋白的抗体反应。在 T2 时，对照组的血清转化率为 92.31%，CKD 患者为 100%，接受 KT 的患者为 42.86%，接受血液透析（HD）的患者为 80.18%，接受持续不卧床腹膜透析（CAPD）的患者为 0%，在 ChAdOx1 nCoV-19 疫苗的 T2 时。替代病毒中和试验的中和抗体水平在每个组中均高于保护水平。KT 组表现出最低的中和抗体和 T 细胞反应。血型 O 和疫苗类型与良好的免疫反应相关。第一剂后，14 人（总人群的 6.6%）经历了 COVID-19 突破性感染。

结论：CKD 和 HD 患者接种疫苗后的免疫反应强烈，与健康对照组相当。我们的研究表明，一剂疫苗并不有效，延迟接种可能导致突破性感染。一些血型和疫苗类型可能会影响免疫反应。