Transplant Institute, Tampa General Hospital and University of South Florida Morsani School of Medicine, Tampa, Florida, USA.
J Infect Dis. 2023 Aug 4;228(Suppl 1):S34-S45. doi: 10.1093/infdis/jiad152.
Solid organ transplant recipients (SOTRs) are at high risk for infections including SARS-CoV-2, primarily due to use of immunosuppressive therapies that prevent organ rejection. Furthermore, these immunosuppressants are typically associated with suboptimal responses to vaccination. While COVID-19 vaccines have reduced the risk of COVID-19-related morbidity and mortality in SOTRs, breakthrough infection rates and death remain higher in this population compared with immunocompetent individuals. Approaches to enhancing response in SOTRs, such as through administration of additional doses and heterologous vaccination, have resulted in increased seroresponse and antibody levels. In this article, safety and immunogenicity of mRNA COVID-19 vaccines in SOTRs are explored by dose. Key considerations for clinical practice and the current vaccine recommendations for SOTRs are discussed within the context of the dynamic COVID-19 vaccination guideline landscape. A thorough understanding of these topics is essential for determining public health and vaccination strategies to help protect immunocompromised populations, including SOTRs.
实体器官移植受者（SOTR）感染 SARS-CoV-2 的风险很高，主要是由于使用了免疫抑制疗法以防止器官排斥。此外，这些免疫抑制剂通常与疫苗接种的反应不理想有关。虽然 COVID-19 疫苗降低了 SOTR 中与 COVID-19 相关的发病率和死亡率，但与免疫功能正常的个体相比，该人群的突破性感染率和死亡率仍然较高。通过给予额外剂量和异源疫苗接种等方法来提高 SOTR 的反应，已导致血清反应和抗体水平增加。本文探讨了 SOTR 中按剂量使用 mRNA COVID-19 疫苗的安全性和免疫原性。根据 COVID-19 疫苗接种指南的动态景观，讨论了 SOTR 临床实践的关键注意事项和当前疫苗推荐。为了确定保护免疫功能低下人群（包括 SOTR）的公共卫生和疫苗接种策略，深入了解这些问题至关重要。
