Emmanouilidou-Fotoulaki Elpida, Karava Vasiliki, Dotis John, Kondou Antonia, Printza Nikoleta
Pediatric Nephrology Unit, 1st Department of Pediatrics, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece.
Vaccines (Basel). 2023 Jun 9;11(6):1080. doi: 10.3390/vaccines11061080.
The pediatric population is at a lower risk of severe SARS-CoV-2 infection compared to adults. Nevertheless, immunosuppression in pediatric and adolescent kidney transplant recipients (KTRs) increases their hazard compared to the general population. This systematic review evaluates the efficacy of SARS-CoV-2 vaccines and determines the risk factors of no seroconversion in this population. PubMed-MEDLINE databases were searched for cohort studies. A meta-analysis was performed using fixed and random effect models. In total, seven studies including 254 patients were further analyzed. The random effect model demonstrated a 63% seroconversion rate (95% CI 0.5, 0.76) following a two-dose schedule, which increased to 85% (95% CI 0.76, 0.93) after the third dose administration. Seropositivity was lower in patients under mycophenolate mofetil compared to azathioprine (OR 0.09, 95% CI 0.02, 0.43). Rituximab administration decreased the seroconversion rate (OR 0.12, 95% CI 0.03, 0.43). The glomerular filtration rate (GFR) was 9.25 mL/min/1.73 m lower (95% CI 16.37, 2.13) in patients with no seroconversion. The seroconversion rate was lower in vaccinated compared to infected patients (OR 0.13, 95% CI 0.02, 0.72). In conclusion, vaccination against SARS-CoV-2 in pediatric and adolescent KTRs elicits a humoral response, and a third dose is advised. Previous rituximab administration, antimetabolite therapy with mycophenolate mofetil and lower GFR reduce the likelihood for seroconversion.
与成年人相比，儿科人群感染严重SARS-CoV-2的风险较低。然而，与普通人群相比，儿科和青少年肾移植受者（KTRs）的免疫抑制增加了他们的风险。本系统评价评估了SARS-CoV-2疫苗的疗效，并确定了该人群中无血清转化的风险因素。在PubMed-MEDLINE数据库中检索队列研究。使用固定效应模型和随机效应模型进行荟萃分析。总共对包括254例患者的7项研究进行了进一步分析。随机效应模型显示，两剂接种方案后的血清转化率为63%（95%CI 0.5，0.76），第三剂接种后升至85%（95%CI 0.76，0.93）。与硫唑嘌呤相比，接受霉酚酸酯治疗的患者血清阳性率较低（OR 0.09，95%CI 0.02，0.43）。使用利妥昔单抗降低了血清转化率（OR 0.12，95%CI 0.03，0.43）。无血清转化患者的肾小球滤过率（GFR）低9.25 mL/min/1.73 m²（95%CI 16.37，2.13）。与感染患者相比，接种疫苗患者的血清转化率较低（OR 0.13，95%CI 0.02，0.72）。总之，儿科和青少年KTRs接种SARS-CoV-2疫苗可引发体液反应，建议接种第三剂。既往使用利妥昔单抗、霉酚酸酯抗代谢物治疗和较低的GFR会降低血清转化的可能性。
