Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, United Kingdom.
Imperial College Renal and Transplant Centre, Imperial College Healthcare National Healthcare Service Trust, Hammersmith Hospital, London, United Kingdom.
Front Immunol. 2023 Jan 16;13:1083167. doi: 10.3389/fimmu.2022.1083167. eCollection 2022.
SARS-CoV-2 vaccines are recommended pre-transplantation, however, waning immunity and evolving variants mandate booster doses. Currently there no data to inform the optimal timing of booster doses post-transplant, in patients primed pre-transplant. We investigated serial serological samples in 204 transplant recipients who received 2 or 3 SARS-CoV-2 vaccines pre-transplant. Spike protein antibody concentrations, [anti-S], were measured on the day of transplantation and following booster doses post-transplant. In infection-naïve patients, post-booster [anti-S] did not change when V3 (1 booster) was given at 116(78-150) days post-transplant, falling from 122(32-574) to 111(34-682) BAU/ml, p=0.78. Similarly, in infection-experienced patients, [anti-S] on Day-0 and post-V3 were 1090(133-3667) and 2207(650-5618) BAU/ml respectively, p=0.26. In patients remaining infection-naïve, [anti-S] increased post-V4 (as 2 booster) when given at 226(208-295) days post-transplant, rising from 97(34-1074) to 5134(229-5680) BAU/ml, p=0.0016. Whilst in patients who had 3 vaccines pre-transplant, who received V4 (as 1 booster) at 82(49-101) days post-transplant, [anti-S] did not change, falling from 981(396-2666) to 871(242-2092) BAU/ml, p=0.62. Overall, infection pre-transplant and [anti-S] at the time of transplantation predicted post-transplant infection risk. As [Anti-S] fail to respond to SARS-CoV-2 booster vaccines given early post-transplant, passive immunity may be beneficial to protect patients during this period.
SARS-CoV-2 疫苗推荐在移植前接种，然而，免疫减弱和不断演变的变异株需要加强针。目前，尚无数据表明在移植前已接种疫苗的患者中，移植后加强针的最佳时间。我们研究了 204 名接受过 2 或 3 剂 SARS-CoV-2 疫苗的移植受者的连续血清学样本。在移植当天和移植后接受加强针时测量 Spike 蛋白抗体浓度[anti-S]。在无感染的患者中，当 V3（1 剂加强针）在移植后 116（78-150）天时给予时，[anti-S]在接种后没有变化，从 122（32-574）降至 111（34-682） BAU/ml，p=0.78。同样，在有感染史的患者中，V3 后第 0 天和第 V3 天的[anti-S]分别为 1090（133-3667）和 2207（650-5618） BAU/ml，p=0.26。在仍无感染的患者中，当 V4（作为 2 剂加强针）在移植后 226（208-295）天时给予时，[anti-S]在接种后增加，从 97（34-1074）升至 5134（229-5680） BAU/ml，p=0.0016。而在移植前接受过 3 剂疫苗的患者中，当 V4（作为 1 剂加强针）在移植后 82（49-101）天时给予时，[anti-S]没有变化，从 981（396-2666）降至 871（242-2092） BAU/ml，p=0.62。总的来说，移植前的感染和移植时的[anti-S]预测了移植后的感染风险。由于[SARS-CoV-2 加强针]不能早期应答，因此被动免疫可能有助于在此期间保护患者。
