Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
Transpl Int. 2023 Feb 6;36:10883. doi: 10.3389/ti.2023.10883. eCollection 2023.
Among heart transplant (HT) recipients, a reduced immunological response to SARS-CoV-2 vaccination has been reported. We aimed to assess the humoral and T-cell response to SARS-CoV-2 vaccination in HT recipients to understand determinants of immunogenicity. HT recipients were prospectively enrolled from January 2021 until March 2022. Anti-SARS-CoV-2-Spike IgG levels were quantified after two and three doses of a SARS-CoV-2 vaccine (BNT162b2, mRNA1273, or AZD1222). Spike-specific T-cell responses were assessed using flow cytometry. Ninety-one patients were included in the study (69% male, median age 55 years, median time from HT to first vaccination 6.1 years). Seroconversion rates were 34% after two and 63% after three doses. Older patient age ( = 0.003) and shorter time since HT ( = 0.001) were associated with lower antibody concentrations after three vaccinations. There were no associations between vaccine types or immunosuppressive regimens and humoral response, except for prednisolone, which was predictive of a reduced response after two ( = 0.001), but not after three doses ( = 0.434). A T-cell response was observed in 50% after two and in 74% after three doses. Despite three vaccine doses, a large proportion of HT recipients exhibits a reduced immune response. Additional strategies are desirable to improve vaccine immunogenicity in this vulnerable group of patients.
在心脏移植（HT）受者中，有报道称对 SARS-CoV-2 疫苗的免疫反应降低。我们旨在评估 HT 受者对 SARS-CoV-2 疫苗接种的体液和 T 细胞反应，以了解免疫原性的决定因素。从 2021 年 1 月到 2022 年 3 月，前瞻性地招募了 HT 受者。在接种两剂和三剂 SARS-CoV-2 疫苗（BNT162b2、mRNA1273 或 AZD1222）后，定量检测抗 SARS-CoV-2-Spike IgG 水平。使用流式细胞术评估 Spike 特异性 T 细胞反应。本研究共纳入 91 例患者（69%为男性，中位年龄为 55 岁，从 HT 到首次接种的中位时间为 6.1 年）。两剂和三剂后血清转化率分别为 34%和 63%。较年长的患者年龄（ = 0.003）和较短的 HT 后时间（ = 0.001）与三剂后抗体浓度较低相关。疫苗类型或免疫抑制方案与体液反应之间无相关性，但泼尼松与两剂后反应降低有关（ = 0.001），与三剂后反应无关（ = 0.434）。两剂和三剂后分别有 50%和 74%的患者观察到 T 细胞反应。尽管接种了三剂疫苗，但很大一部分 HT 受者表现出免疫反应降低。需要额外的策略来提高这一脆弱患者群体的疫苗免疫原性。
