Cheng Chih-Hsien, Hung Hao-Chien, Lee Jin-Chiao, Huang Po-Wei, Gu Po-Wen, Lai Yin, Wang Yu-Chao, Wu Tsung-Han, Lee Chen-Fang, Wu Ting-Jung, Chou Hong-Shiue, Chan Kun-Ming, Huang Chung-Guei, Lee Wei-Chen
Department of General Surgery, Division of Liver and Transplantation Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
Department of Laboratory Medicine, Chang-Gung Memorial Hospital, Taoyuan 333, Taiwan.
Vaccines (Basel). 2022 Oct 29;10(11):1827. doi: 10.3390/vaccines10111827.
Liver transplant recipients on chronic immunosuppression show an attenuated antibody response after SARS-CoV-2 vaccination. Adjusting immunosuppressants during vaccination remains debated. We enrolled 380 liver transplant recipients receiving 2 doses of a protein subunit, mRNA, or a vector vaccine. The patients were informed to temporarily suspend immunosuppression for 2 weeks for both vaccination doses. We measured anti-live-SARS-CoV-2 spike neutralizing antibody levels at 1−2 months after the second vaccination; 83.9% of patients had humoral responses (SARS-CoV-2 NT50 ≥ 9.62 IU/mL) to 2 doses of vaccines. The mRNA (86.7%) and protein subunit vaccines (85%) yielded higher response rates than the vector vaccines (40.9%). Immunosuppression suspension during the two vaccinations yielded a higher response rate (91.5% vs. 57.7%). Only eight patients (2.1%) experienced transaminase level elevation of thrice the normal value (>110 IU/L) after the second vaccination. Most recovered spontaneously after resuming immunosuppression. Multivariate analysis revealed ABO incompatibility, white blood cell count <4000, lymphocyte count <20%, tacrolimus trough level >6.5 ng/mL, and no immunosuppression adjustment as independent risk factors to nonresponse. The mRNA and protein subunit vaccines yielded a higher response rate. Immunosuppression suspension for 2 weeks enhanced the antibody response. ABO incompatibility, leukopenia, lymphopenia, a high tacrolimus trough level, and no immunosuppression adjustment are associated with nonresponse.
接受慢性免疫抑制治疗的肝移植受者在接种新型冠状病毒疫苗后抗体反应减弱。接种疫苗期间调整免疫抑制剂仍存在争议。我们招募了380名接受两剂蛋白亚单位疫苗、信使核糖核酸（mRNA）疫苗或载体疫苗的肝移植受者。告知患者在接种两剂疫苗期间暂时停用免疫抑制剂2周。我们在第二次接种后1至2个月测量了抗活新型冠状病毒刺突中和抗体水平；83.9%的患者对两剂疫苗产生了体液反应（新型冠状病毒中和滴度50%≥9.62 IU/mL）。mRNA疫苗（86.7%）和蛋白亚单位疫苗（85%）的反应率高于载体疫苗（40.9%）。两次接种期间停用免疫抑制剂产生了更高的反应率（91.5%对57.7%）。第二次接种后只有8名患者（2.1%）的转氨酶水平升高至正常值的三倍以上（>110 IU/L）。大多数患者在恢复免疫抑制治疗后自发恢复。多因素分析显示，ABO血型不相容、白细胞计数<4000、淋巴细胞计数<20%、他克莫司谷浓度>6.5 ng/mL以及未调整免疫抑制剂是无反应的独立危险因素。mRNA疫苗和蛋白亚单位疫苗产生了更高的反应率。停用免疫抑制剂2周可增强抗体反应。ABO血型不相容、白细胞减少、淋巴细胞减少、他克莫司谷浓度高以及未调整免疫抑制剂与无反应相关。
