Divison of Internal Medicine, University of Pittsburgh School of Medicine, UPMC, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
Division of Infectious Diseases, University of Pittsburgh School of Medicine, 3601 Fifth Avenue, Falk Medical Building, Suite 5B, Pittsburgh, PA 15213, USA.
Infect Dis Clin North Am. 2023 Sep;37(3):459-473. doi: 10.1016/j.idc.2023.03.002. Epub 2023 Mar 22.
Although COVID-19 vaccines are safe, most organ transplant recipients fail to mount an antibody response after two mRNA vaccines. Thus, three mRNA vaccines constitute a primary vaccine series after solid organ transplant. However, neutralizing antibodies after three or greater mRNA vaccines are lower against Omicron versus older variants. Predictors of attenuated responses include age, vaccination within 1 year from transplant, mycophenolate, and BNT162b2. Some seronegative transplant recipients exhibit durable T-cell responses. Vaccine effectiveness in transplants is lower than in the general population. Immunosuppression reduction around revaccination warrants further study. Monoclonal antibody pre-exposure prophylaxis may be protective against susceptible variants.
虽然 COVID-19 疫苗是安全的，但大多数器官移植受者在接种两剂 mRNA 疫苗后无法产生抗体反应。因此，三种 mRNA 疫苗构成了实体器官移植后的主要疫苗系列。然而，与旧变体相比，三种或更多 mRNA 疫苗后的中和抗体对奥密克戎的反应较低。反应减弱的预测因素包括年龄、移植后 1 年内接种疫苗、霉酚酸酯和 BNT162b2。一些血清阴性的移植受者表现出持久的 T 细胞反应。疫苗在移植受者中的有效性低于普通人群。疫苗接种前后免疫抑制的减少需要进一步研究。单克隆抗体预先暴露预防可能对易感变体具有保护作用。
