Masetti Marco, Scuppa Maria Francesca, Aloisio Alessio, Giovannini Laura, Borgese Laura, Manno Stefania, Tazza Beatrice, Pascale Renato, Bonazzetti Cecilia, Caroccia Natascia, Sabatino Mario, Spitaleri Giosafat, Viale Pierluigi, Giannella Maddalena, Potena Luciano
Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.
Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.
Microorganisms. 2023 Mar 15;11(3):755. doi: 10.3390/microorganisms11030755.
Patients with heart transplantation (HT) have an increased risk of COVID-19 disease and the efficacy of vaccines on antibody induction is lower, even after three or four doses. The aim of our study was to assess the efficacy of four doses on infections and their interplay with immunosuppression. We included in this retrospective study all adult HT patients (12/21-11/22) without prior infection receiving a third or fourth dose of mRNA vaccine. The endpoints were infections and the combined incidence of ICU hospitalizations/death after the last dose (6-month survival rate). Among 268 patients, 62 had an infection, and 27.3% received four doses. Following multivariate analysis, three vs. four doses, mycophenolate (MMF) therapy, and HT < 5 years were associated with an increased risk of infection. MMF ≥ 2000 mg/day independently predicted infection, together with the other variables, and was associated with ICU hospitalization/death. Patients on MMF had lower levels of anti-RBD antibodies, and a positive antibody response after the third dose was associated with a lower probability of infection. In HT patients, a fourth dose of vaccine against SARS-CoV-2 reduces the risk of infection at six months. Mycophenolate, particularly at high doses, reduces the clinical effectiveness of the fourth dose and the antibody response to the vaccine.
心脏移植（HT）患者感染新型冠状病毒肺炎（COVID-19）的风险增加，即使接种三剂或四剂疫苗，其诱导抗体的效果也较低。我们研究的目的是评估四剂疫苗对感染的疗效及其与免疫抑制的相互作用。我们纳入了这项回顾性研究中的所有成年HT患者（2021年12月至2022年11月），这些患者在未发生过感染的情况下接受了第三剂或第四剂mRNA疫苗。观察终点为感染情况以及最后一剂疫苗接种后重症监护病房（ICU）住院/死亡的合并发生率（6个月生存率）。在268例患者中，62例发生感染，27.3%的患者接种了四剂疫苗。多因素分析显示，接种三剂与四剂疫苗、霉酚酸酯（MMF）治疗以及移植时间<5年与感染风险增加相关。MMF≥2000mg/天与其他变量一起独立预测感染，并与ICU住院/死亡相关。接受MMF治疗的患者抗受体结合域（RBD）抗体水平较低，第三剂疫苗接种后抗体反应呈阳性与感染概率较低相关。在HT患者中，第四剂严重急性呼吸综合征冠状病毒2（SARS-CoV-2）疫苗可降低6个月时的感染风险。霉酚酸酯，尤其是高剂量时，会降低第四剂疫苗的临床效果以及疫苗的抗体反应。
