Gemander Nicolas, Kemlin Delphine, Depickère Stéphanie, Kelkar Natasha S, Pannus Pieter, Sharma Shilpee, Waegemans Alexandra, Olislagers Véronique, Georges Daphnée, Dhondt Emilie, Braga Margarida, Heyndrickx Leo, Michiels Johan, Thiriard Anaïs, Lemy Anne, Vandevenne Marylène, Goossens Maria E, Matagne André, Desombere Isabelle, Ariën Kevin K, Ackerman Margaret E, Le Moine Alain, Marchant Arnaud
Institute for Medical Immunology and Université Libre de Bruxelles Centre for Research in Immunology, Université Libre de Bruxelles, Gosselies, Belgium.
Department of Nephrology, Dialysis and Transplantation, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Kidney Int Rep. 2023 Dec 20;9(3):635-648. doi: 10.1016/j.ekir.2023.12.008. eCollection 2024 Mar.
Comorbidities and immunosuppressive therapies are associated with reduced immune responses to primary COVID-19 mRNA vaccination in kidney transplant recipients (KTRs). In healthy individuals, prior SARS-COV-2 infection is associated with increased vaccine responses, a phenotype called hybrid immunity. In this study, we explored the potential influence of immune suppression on hybrid immunity in KTRs.
Eighty-two KTRs, including 59 SARS-CoV-2-naïve (naïve KTRs [N-KTRs]) and 23 SARS-CoV-2-experienced (experienced KTRs [E-KTRs]) patients, were prospectively studied and compared to 106 healthy controls (HCs), including 40 SARS-CoV-2-naïve (N-HCs) and 66 SARS-CoV-2-experienced (E-HCs) subjects. Polyfunctional antibody and T cell responses were measured following 2 doses of BNT162b2 mRNA vaccine. Associations between vaccine responses and clinical characteristics were studied by univariate and multivariate analyses.
In naïve KTRs, vaccine responses were markedly lower than in HCs and were correlated with older age, more recent transplantation, kidney retransplantation after graft failure, arterial hypertension, and treatment with mycophenolate mofetil (MMF). In contrast, vaccine responses of E-KTRs were similar to those of HCs and were associated with time between transplantation and vaccination, but not with the other risk factors associated with low vaccine responses in naïve KTRs.
In conclusion, hybrid immunity overcomes immune suppression and provides potent humoral and cellular immunity to SARS-CoV-2 in KTRs.
合并症和免疫抑制疗法与肾移植受者（KTRs）对原发性COVID-19 mRNA疫苗的免疫反应降低有关。在健康个体中，既往SARS-CoV-2感染与疫苗反应增强有关，这种表型称为混合免疫。在本研究中，我们探讨了免疫抑制对KTRs混合免疫的潜在影响。
前瞻性研究了82例KTRs，包括59例未感染SARS-CoV-2的患者（未感染KTRs [N-KTRs]）和23例感染过SARS-CoV-2的患者（感染过KTRs [E-KTRs]），并与106例健康对照（HCs）进行比较，其中包括40例未感染SARS-CoV-2的个体（N-HCs）和66例感染过SARS-CoV-2的个体（E-HCs）。在接种2剂BNT162b2 mRNA疫苗后测量多功能抗体和T细胞反应。通过单变量和多变量分析研究疫苗反应与临床特征之间的关联。
在未感染KTRs中，疫苗反应明显低于HCs，并且与年龄较大、近期移植、移植失败后肾再次移植、动脉高血压以及霉酚酸酯（MMF）治疗有关。相比之下，E-KTRs的疫苗反应与HCs相似，并且与移植和接种疫苗之间的时间有关，但与未感染KTRs中与低疫苗反应相关的其他风险因素无关。
总之，混合免疫克服了免疫抑制，并为KTRs中的SARS-CoV-2提供了强大的体液和细胞免疫。
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