Service de Pneumologie et Transplantation Pulmonaire, Hôpital Marie Lannelogue, Groupe Hospitalier Paris-Saint Joseph, Le Plessis-Robinson, France.
Service de Transplantation Pulmonaire et Centre de Compétence de la Mucoviscidose, Hôpital Foch, Suresnes, France.
Eur Respir J. 2023 Jan 19;61(1). doi: 10.1183/13993003.00502-2022. Print 2023 Jan.
Do three coronavirus disease 2019 (COVID-19) vaccine doses induce a serological response in lung transplant recipients?
We retrospectively included 1071 adults (551 (52%) males) at nine transplant centres in France. Each had received three COVID-19 vaccine doses in 2021, after lung transplantation. An anti-spike protein IgG response, defined as a titre >264 BAU·mL after the third dose (median (interquartile range (IQR)) 3.0 (1.7-4.1) months), was the primary outcome and adverse events were the secondary outcomes. Median (IQR) age at the first vaccine dose was 54 (40-63) years and median (IQR) time from transplantation to the first dose was 64 (30-110) months.
Median (IQR) follow-up after the first dose was 8.3 (6.7-9.3) months. A vaccine response developed in 173 (16%) patients. Factors independently associated with a response were younger age at vaccination, longer time from transplantation to vaccination and absence of corticosteroid or mycophenolate therapy. After vaccination, 51 (5%) patients (47 non-responders (47/898 (5%)) and four (4/173 (2%)) responders) experienced COVID-19, at a median (IQR) of 6.6 (5.1-7.3) months after the third dose. No responders had severe COVID-19 compared with 15 non-responders, including six who died of the disease.
Few lung transplant recipients achieved a serological response to three COVID-19 vaccine doses, indicating a need for other protective measures. Older age and use of mycophenolate or corticosteroids were associated with absence of a response. The low incidence of COVID-19 might reflect vaccine protection cellular immunity and/or good adherence to shielding measures.
三种新型冠状病毒病 2019（COVID-19）疫苗能否在肺移植受者中诱导血清学反应？
我们回顾性纳入了法国 9 个移植中心的 1071 名成年人（551 名（52%）男性）。他们在肺移植后于 2021 年接受了三剂 COVID-19 疫苗。抗刺突蛋白 IgG 反应定义为第三次剂量后滴度>264 BAU·mL（中位数（四分位距（IQR））3.0（1.7-4.1）个月），是主要结局，不良事件是次要结局。第一次接种疫苗时的中位（IQR）年龄为 54（40-63）岁，从移植到第一次接种疫苗的中位（IQR）时间为 64（30-110）个月。
第一次接种疫苗后的中位（IQR）随访时间为 8.3（6.7-9.3）个月。173 名（16%）患者产生了疫苗反应。与反应相关的独立因素是接种疫苗时年龄较小、从移植到接种疫苗的时间较长以及无皮质类固醇或霉酚酸酯治疗。接种疫苗后，51 名（5%）患者（47 名无反应者（47/898（5%））和 4 名（4/173（2%））有反应者）在第三次剂量后中位（IQR）6.6（5.1-7.3）个月时发生 COVID-19。与 15 名无反应者相比，没有有反应者发生严重 COVID-19，包括 6 名死于该病的患者。
很少有肺移植受者对三种 COVID-19 疫苗剂量产生血清学反应，这表明需要采取其他保护措施。年龄较大、使用霉酚酸酯或皮质类固醇与无反应相关。COVID-19 的低发病率可能反映了疫苗对细胞免疫的保护作用和/或对屏蔽措施的良好依从性。
