Clinical Pathology Unit, "SS. Annunziata" Hospital, Taranto, Italy.
Nephrology and Dialysis Unit, "SS. Annunziata" Hospital, Taranto, Italy.
Clin Exp Nephrol. 2023 May;27(5):445-453. doi: 10.1007/s10157-023-02317-1. Epub 2023 Feb 16.
Vulnerable populations, such as hemodialysis (HD) patients and kidney transplant (RTx) recipients, have priority for anti-COVID-19 vaccination, because of their impaired immune status. Here, we investigated the immune response after vaccination with BNT162b2 (two doses plus booster) in HD and RTx patients.
A prospective, observational study was started in two homogeneous groups of 55 HD and 51 RTx patients previously matched from a cohort of 336 patients. Anti-RBD IgG levels, assayed after the second dose with BNT162b2 mRNA, were used to stratify subjects into quintiles. After the second dose and after booster, anti-RBD and IGRA test were evaluated in RTx and HD, belonging to the first and fifth quintiles.
After the second dose of vaccine, the median circulating levels of anti-RBD IgG were significantly higher in HD (1456 AU/mL) compared to RTx (27.30 AU/mL). IGRA test showed significantly higher values in the HD (382 mIU/mL) compared with the RTx (73 mIU/mL). After the booster, humoral response increased significantly in both HD (p = 0.0002) and RTx groups (p = 0.009), whereas the T-cellular immunity remained essentially stable in most patients. In RTx patients with a low humoral response after the second dose, the third dose did not significantly strengthen either humoral or cellular immunity.
For HD and RTx, there is great variability in the humoral response to anti-COVID-19 vaccination, with a stronger response in the HD group. The booster dose was ineffective at reinforcing the humoral and cellular immune response in most RTx patients hyporesponsive to the second dose.
由于免疫功能受损，血液透析（HD）患者和肾移植（RTx）受者等弱势群体优先进行抗 COVID-19 疫苗接种。在此，我们研究了 BNT162b2（两剂加加强针）接种后 HD 和 RTx 患者的免疫反应。
一项前瞻性观察性研究在两个同质组中进行，每组 55 名 HD 和 51 名 RTx 患者，他们先前从 336 名患者的队列中匹配。在接受 BNT162b2 mRNA 第二次注射后，检测抗 RBD IgG 水平，并将患者分为五组。在接受第二次剂量和加强针后，在 RTx 和 HD 中评估抗 RBD 和 IGRA 测试，属于第一和第五五分位数。
在接种疫苗后的第二次剂量后，HD 组的循环抗 RBD IgG 中位数明显高于 RTx 组（1456 AU/mL 比 27.30 AU/mL）。IGRA 测试显示 HD 组的数值明显高于 RTx 组（382 mIU/mL 比 73 mIU/mL）。在加强针后，HD（p=0.0002）和 RTx 组（p=0.009）的体液反应均显著增加，而大多数患者的 T 细胞免疫基本保持稳定。在第二次剂量后体液反应低的 RTx 患者中，第三剂在增强体液或细胞免疫方面没有显著作用。
对于 HD 和 RTx，对抗 COVID-19 疫苗接种的体液反应存在很大的变异性，HD 组的反应更强。在大多数对第二剂量反应不佳的 RTx 患者中，加强剂量对增强体液和细胞免疫反应无效。
