Hausinger Renate Ilona, Bachmann Quirin, Crone-Rawe Timotius, Hannane Nora, Monsef Ina, Haller Bernhard, Heemann Uwe, Skoetz Nicole, Kreuzberger Nina, Schmaderer Christoph
Department of Nephrology, Klinikum Rechts der Isar, TUM School of Medicine, Technical University of Munich, 81675 Munich, Germany.
Evidence-Based Medicine, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany.
Vaccines (Basel). 2023 Apr 18;11(4):863. doi: 10.3390/vaccines11040863.
Kidney transplant recipients (KTRs) who have a highly impaired immune response are in need of intensified and safe vaccination strategies to achieve seroconversion and prevent severe disease.
We searched the Web of Science Core Collection, the Cochrane COVID-19 Study Register and the WHO COVID-19 global literature on coronavirus disease from January 2020 to 22 July 2022 for prospective studies that assessed immunogenicity and efficacy after three or more SARS-CoV-2 vaccine doses.
In 37 studies on 3429 patients, de novo seroconversion after three and four vaccine doses ranged from 32 to 60% and 25 to 37%. Variant-specific neutralization was 59 to 70% for Delta and 12 to 52% for Omicron. Severe disease after infection was rarely reported but all concerned KTRs lacked immune responses after vaccination. Studies investigating the clinical course of COVID-19 found remarkably higher rates of severe disease than in the general population. Serious adverse events and acute graft rejections were very rare. Substantial heterogeneity between the studies limited their comparability and summary.
Additional SARS-CoV-2 vaccine doses are potent and safe in general terms as well as regarding transplant-specific outcomes whilst the Omicron wave remains a significant threat to KTRs without adequate immune responses.
免疫反应严重受损的肾移植受者（KTRs）需要强化且安全的疫苗接种策略，以实现血清转化并预防严重疾病。
我们检索了科学网核心合集、Cochrane COVID-19研究注册库以及世界卫生组织关于2020年1月至2022年7月22日冠状病毒病的COVID-19全球文献，以查找评估三剂或更多剂严重急性呼吸综合征冠状病毒2（SARS-CoV-2）疫苗后的免疫原性和疗效的前瞻性研究。
在针对3429名患者的37项研究中，三剂和四剂疫苗后的初次血清转化范围分别为32%至60%和25%至37%。针对Delta变异株的特异性中和率为59%至70%，针对Omicron变异株的为12%至52%。感染后严重疾病的报告很少，但所有相关的KTRs在接种疫苗后均缺乏免疫反应。调查COVID-19临床病程的研究发现，严重疾病的发生率明显高于普通人群。严重不良事件和急性移植排斥反应非常罕见。研究之间存在大量异质性，限制了它们的可比性和总结。
额外剂量的SARS-CoV-2疫苗总体上以及在移植特异性结局方面都是有效且安全的，而在Omicron疫情期间，对于没有足够免疫反应的KTRs仍然是一个重大威胁。
