Gemander Nicolas, Kemlin Delphine, Depickère Stéphanie, Kelkar Natasha S, Sharma Shilpee, Pannus Pieter, Waegemans Alexandra, Olislagers Véronique, Georges Daphnée, Dhondt Emilie, Braga Margarida, Heyndrickx Leo, Michiels Johan, Thiriard Anaïs, Lemy Anne, Baudoux Thomas, Vandevenne Marylène, Goossens Maria E, Matagne André, Desombere Isabelle, Ariën Kevin K, Ackerman Margaret E, Le Moine Alain, Marchant Arnaud
European Plotkin Institute for Vaccinology, Université libre de Bruxelles (ULB), Brussels and ULB Centre for Research in Immunology (U-CRI), Université libre de Bruxelles (ULB), Gosselies, Belgium; Department of Nephrology, Dialysis and Transplantation, Erasme Hospital, Université libre de Bruxelles (ULB), Brussels, Belgium.
European Plotkin Institute for Vaccinology, Université libre de Bruxelles (ULB), Brussels and ULB Centre for Research in Immunology (U-CRI), Université libre de Bruxelles (ULB), Gosselies, Belgium; Department of Nephrology, Dialysis and Transplantation, Erasme Hospital, Université libre de Bruxelles (ULB), Brussels, Belgium.
Vaccine. 2025 Jan 12;44:126544. doi: 10.1016/j.vaccine.2024.126544. Epub 2024 Nov 29.
Clinical risk factors of deficient immune responses to COVID-19 mRNA vaccination in SARS-CoV-2 naive hemodialysis recipients (HDR) have already been identified. Clinical factors influencing hybrid immunity induced by SARS-CoV-2 infection and vaccination in HDR have not been reported.
A comprehensive analysis of antibody (Ab) and T cell responses to two doses of BNT162b2 mRNA vaccination was performed in 103 HDR, including 75 SARS-CoV-2 naive and 28 experienced patients, and in 106 healthy controls (HC) not undergoing HD, including 40 SARS-CoV-2 naive and 66 experienced subjects. Clinical risk factors associated with lower humoral and cellular immunity were analyzed in SARS-CoV-2 naive and experienced HDR by univariate and multivariate analyses.
Naive HDR had lower neutralizing and non-neutralizing antibody responses to vaccination than naive HC; lower vaccine responses were correlated with previous transplantation, immunosuppressive treatment, corticosteroid treatment, hypoalbuminemia, older age, hypertension, and negative response to hepatitis B vaccination. In contrast, vaccine responses of SARS-CoV-2 experienced HDR were similar to those of HC and were correlated with time between infection and vaccination and with previous transplantation, but not with the other risk factors associated with lower vaccine responses in naive HDR.
COVID-19 vaccine responses are influenced by distinct risk factors in SARS-CoV-2 naive and experienced HDR. These observations have important implications for the understanding of vaccine-induced immunity and for the management of this vulnerable patient population.
已确定了未感染过严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的血液透析患者（HDR）对2019冠状病毒病（COVID-19）信使核糖核酸（mRNA）疫苗免疫反应不足的临床风险因素。尚未有关于影响SARS-CoV-2感染和疫苗接种在HDR中诱导的混合免疫的临床因素的报道。
对103名HDR（包括75名未感染过SARS-CoV-2的患者和28名有感染史的患者）以及106名未接受血液透析的健康对照者（HC，包括40名未感染过SARS-CoV-2的受试者和66名有感染史的受试者）进行了针对两剂BNT162b2 mRNA疫苗的抗体（Ab）和T细胞反应的综合分析。通过单因素和多因素分析，对未感染过SARS-CoV-2的和有感染史的HDR中与较低体液免疫和细胞免疫相关的临床风险因素进行了分析。
未感染过SARS-CoV-2的HDR对疫苗接种的中和抗体和非中和抗体反应低于未感染过SARS-CoV-2的HC；较低的疫苗反应与既往移植、免疫抑制治疗、皮质类固醇治疗、低白蛋白血症、高龄、高血压以及对乙型肝炎疫苗接种的阴性反应相关。相比之下，有SARS-CoV-2感染史的HDR的疫苗反应与HC相似，且与感染和疫苗接种之间的时间以及既往移植相关，但与未感染过SARS-CoV-2的HDR中与较低疫苗反应相关的其他风险因素无关。
在未感染过SARS-CoV-2的和有感染史的HDR中，COVID-19疫苗反应受不同风险因素影响。这些观察结果对理解疫苗诱导的免疫以及对这一脆弱患者群体的管理具有重要意义。
