肾移植受者中 SARS-CoV-2 疫苗接种的细胞免疫反应：系统评价和荟萃分析。
Cellular immune response of SARS-CoV-2 vaccination in kidney transplant recipients: a systematic review and meta-analysis.
机构信息
Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Excellence Center for Organ Transplantation (ECOT), King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
出版信息
Front Immunol. 2023 Jul 26;14:1220148. doi: 10.3389/fimmu.2023.1220148. eCollection 2023.
BACKGROUND
Evidence has demonstrated inferior humoral immune responses after SARS-CoV-2 vaccination in kidney transplant recipients compared to the general population. However, data on cellular immune responses in this population have not been established.
METHODS
We searched the MEDLINE, Scopus, and Cochrane databases and included studies reporting cellular immune response rates in kidney transplant recipients after receiving SARS-CoV-2 vaccines. Studies that reported factors associated with cellular immune responders or non-responders were also included (PROSPERO: CRD42022375544).
RESULTS
From a total of 1,494 articles searched, 53 articles were included in the meta-analysis. In all, 21 studies assessed cellular immune response by interferon-γ enzyme-linked immunosorbent spot (IFN-γ ELISPOT), 22 studies used interferon-γ release assay (IGRA), and 10 studies used flow cytometric analysis. The pooled response rate after two doses (standard regimen) and three doses of vaccination was 47.5% (95%CI 38.4-56.7%) and 69.1% (95%CI 56.3-80.6%) from IFN-γ ELISPOT, 25.8% (95%CI 19.7-32.4%) and 14.7% (95%CI 8.5-22.2%) from IGRA, and 73.7% (95%CI 55.2-88.8%) and 86.5% (95%CI 75.3-94.9%) from flow cytometry, respectively. Recipients with seroconversion were associated with a higher chance of having cellular immune response (OR 2.58; 95%CI 1.89-3.54). Cellular immune response in kidney transplant recipients was lower than in dialysis patients (OR 0.24; 95%CI 0.16-0.34) and the general population (OR 0.10; 95%CI 0.07-0.14). Age and immunosuppressants containing tacrolimus or corticosteroid were associated with inferior cellular immune response.
CONCLUSION
Cellular immune response after SARS-CoV-2 vaccination in kidney transplant recipients was lower than in dialysis patients and the general population. Age, tacrolimus, and corticosteroid were associated with poor response. Cellular immune response should also be prioritized in vaccination studies.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier CRD42022375544.
背景
与一般人群相比，肾移植受者接种 SARS-CoV-2 疫苗后体液免疫应答较差。然而，目前尚未确定该人群的细胞免疫应答数据。
方法
我们检索了 MEDLINE、Scopus 和 Cochrane 数据库，并纳入了报告肾移植受者接种 SARS-CoV-2 疫苗后细胞免疫应答率的研究。还纳入了报告与细胞免疫应答者或无应答者相关因素的研究（PROSPERO：CRD42022375544）。
结果
从总共搜索到的 1494 篇文章中，有 53 篇文章被纳入荟萃分析。共有 21 项研究通过干扰素-γ酶联免疫斑点（IFN-γ ELISPOT）评估细胞免疫应答，22 项研究使用干扰素-γ释放试验（IGRA），10 项研究使用流式细胞术分析。IFN-γ ELISPOT 检测显示，两剂（标准方案）和三剂疫苗接种后的总体应答率分别为 47.5%（95%CI 38.4-56.7%）和 69.1%（95%CI 56.3-80.6%），IGRA 检测的应答率分别为 25.8%（95%CI 19.7-32.4%）和 14.7%（95%CI 8.5-22.2%），流式细胞术检测的应答率分别为 73.7%（95%CI 55.2-88.8%）和 86.5%（95%CI 75.3-94.9%）。血清转换的受者发生细胞免疫应答的可能性更高（OR 2.58；95%CI 1.89-3.54）。肾移植受者的细胞免疫应答低于透析患者（OR 0.24；95%CI 0.16-0.34）和一般人群（OR 0.10；95%CI 0.07-0.14）。年龄和含有他克莫司或皮质类固醇的免疫抑制剂与较差的细胞免疫应答相关。
结论
与透析患者和一般人群相比，肾移植受者接种 SARS-CoV-2 疫苗后的细胞免疫应答较低。年龄、他克莫司和皮质类固醇与不良反应相关。细胞免疫应答也应在疫苗接种研究中得到重视。
系统评价注册
https://www.crd.york.ac.uk/prospero/，标识符 CRD42022375544。
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