Mahallawi Waleed H, Alharbi Wael A, Aloufi Sultan A, Ibrahim Nadir A, Abdelrahman Muntasir M, Alhomayeed Bader A, Aboonq Moutasem S, Alqahtani Saeed Awad M, Rajih Emad S, Bakhsh Abdulaziz M, Sandokji Ibrahim
Medical Laboratory Technology Department, College of Applied Medical Sciences, Taibah University, Madinah, Saudi Arabia.
King Fahad Hospital, Ministry of Health, Madinah, Saudi Arabia.
Infect Drug Resist. 2023 May 9;16:2829-2840. doi: 10.2147/IDR.S408686. eCollection 2023.
Kidney transplant recipients (KTRs) commonly suffer from impaired immunity. KTRs' compromised immune response to COVID-19 vaccines indicates urgent revision of immunisation policies.
A cross-sectional study was conducted in Madinah, Saudi Arabia of 84 KTRs who had received at least one dose of a COVID-19 vaccine. ELISA was used to evaluate anti-spike SARS-CoV-2 IgG and IgM antibody levels in blood samples obtained one month and seven months after vaccination. Univariate and multivariate analyses were performed to identify associations between seropositive status and factors such as the number of vaccine doses, transplant age, and immunosuppressive therapies.
The mean age of KTRs was 44.3 ± 14.7 years. The IgG antibody seropositivity rate (n=66, 78.5%) was significantly higher than the seronegativity rate (n=18, 21.4%) in the whole cohort (p<0.001). In KTRs seroconverting after one month (n=66), anti-SARS-CoV-2 IgG levels declined significantly between one month (median [IQR]:3 [3-3]) and seven months (2.4 [1.7-2.6]) after vaccination (p<0.01). In KTRs with hypertension, IgG levels significantly decreased between one and seven months after vaccination (p<0.01). IgG levels also decreased significantly in KTRs with a transplant of >10 years (p=0.02). Maintenance immunosuppressive regimens (triple immunosuppressive therapy and steroid-based and antimetabolite-based regimens) led to a significant decrease in IgG levels between the first and second sample (p<0.01). KTRs receiving three vaccine doses showed higher antibody levels than those receiving a single dose or two doses, but the levels decreased significantly between one (median [IQR]: 3 [3-3]) and seven months (2.4 [1.9-2.6]) after vaccination (p<0.01).
KTRs' humoral response after SARS-CoV-2 vaccination is dramatically inhibited and wanes. Antibody levels show a significant decline over time in KTRs with hypertension; receiving triple immunosuppressive therapy or steroid-based or antimetabolite-based regimens; receiving mixed mRNA and viral vector vaccines; and with a transplant of >10 years.
肾移植受者（KTRs）普遍存在免疫功能受损的情况。KTRs对新冠疫苗的免疫反应受损，这表明迫切需要修订免疫政策。
在沙特阿拉伯麦地那对84名至少接种过一剂新冠疫苗的KTRs进行了一项横断面研究。采用酶联免疫吸附测定（ELISA）法评估接种疫苗1个月和7个月后采集的血样中抗新冠病毒刺突蛋白的IgG和IgM抗体水平。进行单因素和多因素分析，以确定血清反应阳性状态与疫苗接种剂量数、移植年龄和免疫抑制治疗等因素之间的关联。
KTRs的平均年龄为44.3±14.7岁。在整个队列中，IgG抗体血清反应阳性率（n = 66，78.5%）显著高于血清反应阴性率（n = 18，21.4%）（p<0.001）。在接种疫苗1个月后血清阳转的KTRs（n = 66）中，抗新冠病毒IgG水平在接种疫苗1个月（中位数[四分位间距]：3[3 - 3]）至7个月（2.4[1.7 - 2.6]）之间显著下降（p<0.01）。在患有高血压的KTRs中，接种疫苗1个月至7个月之间IgG水平显著下降（p<0.01）。移植时间超过10年的KTRs中IgG水平也显著下降（p = 0.02）。维持免疫抑制方案（三联免疫抑制治疗以及基于类固醇和抗代谢物的方案）导致第一次和第二次采样之间IgG水平显著下降（p<0.01）。接种三剂疫苗的KTRs的抗体水平高于接种一剂或两剂的KTRs，但在接种疫苗1个月（中位数[四分位间距]：3[3 - 3]）至7个月（2.4[1.9 - 2.6]）之间水平显著下降（p<0.01）。
KTRs在接种新冠病毒疫苗后的体液免疫反应受到显著抑制且逐渐减弱。在患有高血压、接受三联免疫抑制治疗或基于类固醇或抗代谢物的方案、接种混合mRNA和病毒载体疫苗以及移植时间超过10年的KTRs中，抗体水平随时间显著下降。
