Lammert Alexander, Schnuelle Peter, Rabenau Holger F, Ciesek Sandra, Krämer Bernhard K, Göttmann Uwe, Drüschler Felix, Keller Christine, Rose Daniela, Blume Carsten, Thomas Michael, Kohmer Niko, Lammert Anne
NEDDGrünstadt, Grünstadt, Germany.
Department of Medicine V, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
Transplant Direct. 2022 Oct 14;8(11):e1384. doi: 10.1097/TXD.0000000000001384. eCollection 2022 Nov.
Kidney transplant recipients are at increased risk of SARS-CoV-2 infection and a more severe course of COVID-19.
We conducted a quantitative serologic testing of antibodies specific for the wild type of SARS-CoV-2 and the Omicron variant of concern before and after a third-dose vaccination, either mRNA-1273 (Moderna) or BNT162b2 (Pfizer-BioNTech) in a cohort of 103 stable kidney transplant recipients (median [range] age, 58 [22-84] y, 57 men [55.3%]).
Third-dose vaccination increased the seroconversion rate from 57.3% to 71.8%. However, despite a marked rise of the antibody concentrations after the booster, 55.4% and 11.6% only formed neutralizing antibodies against the SARS-CoV-2 wild type and Omicron, respectively. Treatment with mycophenolic acid/mycophenolate mofetil (in strata of the dose quartiles), advanced age, and' above all' impaired renal function (eGFR <60 mL/min) adversely influenced the humoral immunity regarding seroconversion and inhibition of the wild type of SARS-CoV-2.
Apart from immunosuppressive therapy, the humoral vaccination response is largely affected by nonmodifiable factors in kidney transplant recipients. With the currently leading and clinically easier Omicron variant, this puts into perspective the strategy to significantly enhance the protective efficacy of the available vaccines by reducing or temporarily stopping proliferation inhibitors, not least considering the inherent rejection risk with a possible deterioration of graft function.
肾移植受者感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的风险增加，感染新型冠状病毒肺炎（COVID-19）的病程更严重。
我们对103名稳定的肾移植受者（年龄中位数[范围]为58[22 - 84]岁，57名男性[55.3%]）进行了第三剂疫苗接种（mRNA-1273[Moderna]或BNT162b2[辉瑞-生物科技公司]）前后针对SARS-CoV-2野生型和关注的奥密克戎变异株特异性抗体的定量血清学检测。
第三剂疫苗接种使血清转化率从57.3%提高到71.8%。然而，尽管加强免疫后抗体浓度显著升高，但分别只有55.4%和11.6%的受者形成了针对SARS-CoV-2野生型和奥密克戎的中和抗体。霉酚酸/霉酚酸酯治疗（按剂量四分位数分层）、高龄以及最重要的是肾功能受损（估计肾小球滤过率<60 mL/min）对血清转化和对SARS-CoV-2野生型的抑制方面的体液免疫产生不利影响。
除免疫抑制治疗外，肾移植受者的体液疫苗接种反应在很大程度上受不可改变因素的影响。对于目前占主导且临床上更易感染的奥密克戎变异株，这使通过减少或暂时停用增殖抑制剂来显著提高现有疫苗保护效力的策略受到质疑，尤其是考虑到可能导致移植物功能恶化的固有排斥风险。
