Kabbani Dima, Yotis Demitra M, Ferreira Victor H, Shalhoub Sarah, Belga Sara, Tyagi Varalika, Ierullo Matthew, Kulasingam Vathany, Hébert Marie-Josée, West Lori, Delisle Jean-Sébastien, Racine Normand, De Serres Sacha A, Cardinal Héloïse, Dieudé Mélanie, Humar Atul, Kumar Deepali
Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Canadian Donation and Transplantation Research Program (CDTRP), Edmonton, Alberta, Canada.
Open Forum Infect Dis. 2023 Apr 13;10(5):ofad200. doi: 10.1093/ofid/ofad200. eCollection 2023 May.
Solid organ transplant (SOT) recipients are at risk for severe coronavirus disease 2019 (COVID-19), despite vaccination. Our study aimed to elucidate COVID-19 vaccine immunogenicity and evaluate adverse events such as hospitalization, rejection, and breakthrough infection in a SOT cohort.
We performed a prospective, observational study on 539 adult SOT recipients (age ≥18 years old) recruited from 7 Canadian transplant centers. Demographics including transplant characteristics, vaccine types, and immunosuppression and events such as hospitalization, infection, and rejection were recorded. Follow ups occurred every 4-6 weeks postvaccination and at 6 and 12 months from first dose. Serum was processed from whole blood to measure anti-receptor binding domain (RBD) antibodies of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein to assess immunogenicity.
The COVID-19 vaccines were found to be safe in SOT recipients with low rates of rejection requiring therapy (0.7%). Immunogenicity improved after the third vaccine dose, yet 21% developed no anti-RBD response. Factors such as older age, lung transplantation, chronic kidney disease, and shorter duration from transplant were associated with decreased immunogenicity. Patients with at least 3 doses were protected from hospitalization when experiencing breakthrough infections. Significantly increased anti-RBD levels were observed in patients who received 3 doses and had breakthrough infection.
Three or four doses of COVID-19 vaccines were safe, increased immunogenicity, and protected against severe disease requiring hospitalization. Infection paired with multiple vaccinations significantly increased anti-RBD response. However, SOT populations should continue to practice infection prevention measures, and they should be prioritized for SARS-CoV-2 pre-exposure prophylactics and early therapeutics.
尽管接种了疫苗，但实体器官移植（SOT）受者仍有患重症2019冠状病毒病（COVID-19）的风险。我们的研究旨在阐明COVID-19疫苗的免疫原性，并评估SOT队列中的不良事件，如住院、排斥反应和突破性感染。
我们对从7个加拿大移植中心招募的539名成年SOT受者（年龄≥18岁）进行了一项前瞻性观察研究。记录了包括移植特征、疫苗类型、免疫抑制情况等人口统计学信息，以及住院、感染和排斥反应等事件。接种疫苗后每4-6周进行一次随访，并在首剂接种后的6个月和12个月进行随访。从全血中提取血清，以检测严重急性呼吸综合征冠状病毒2（SARS-CoV-2）刺突蛋白的抗受体结合域（RBD）抗体，以评估免疫原性。
发现COVID-19疫苗在SOT受者中是安全的，需要治疗的排斥反应发生率较低（0.7%）。第三剂疫苗接种后免疫原性有所改善，但仍有21%的人未产生抗RBD反应。年龄较大、肺移植、慢性肾病以及移植后时间较短等因素与免疫原性降低有关。至少接种3剂疫苗的患者在发生突破性感染时可预防住院。在接种3剂疫苗且发生突破性感染的患者中，观察到抗RBD水平显著升高。
三剂或四剂COVID-19疫苗是安全的，可提高免疫原性，并预防需要住院治疗的重症疾病。感染与多次接种疫苗相结合可显著提高抗RBD反应。然而，SOT人群应继续采取感染预防措施，并且应优先考虑进行SARS-CoV-2暴露前预防和早期治疗。
