实体器官移植受者接种新冠病毒疫苗后的长期免疫反应。
Long-term immune response after SARS-CoV2 vaccination in solid organ transplant recipients.
作者信息
Bonazzetti Cecilia, Toschi Alice, Gibertoni Dino, Caroccia Natascia, Di Chiara Michela, Vituliano Silvia, Lanna Federica, Croci Alessandro, Tazza Beatrice, Amicucci Armando, Morelli Maria Cristina, Comai Giorgia, Salvaterra Elena, Potena Luciano, Viale Pierluigi, Giannella Maddalena, Lazzarotto Tiziana
机构信息
Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Infectious Diseases Unit, Department of Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
出版信息
BMC Infect Dis. 2025 Apr 25;25(1):606. doi: 10.1186/s12879-024-10377-1.
BACKGROUND
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) vaccination in solid organ transplant (SOT) recipients is associated with suboptimal antibody response (AbR) favouring breakthrough infection (BI). The role of cell-mediated immunity (CMI) remains uncertain.
METHODS
Single-center prospective longitudinal cohort study of adult SOT recipients monitored for both AbR and CMI at 6 ± 2 months after booster dosage of SARS-CoV-2 vaccine. Primary end-point was BI diagnosis and CMI was the main risk factor. Relationship between CMI and BI was investigated by bivariate tests and multivariable logistic regression.
RESULTS
CMI was performed in 139 patients. In 66 patients BI was documented before CMI, thus 73 (33 kidney, 24 liver, 14 lung, 2 heart) were analysed. The first 2 vaccine doses consisted of BNT162b2 and mRNA-1273 in 69.1% and 30.9% of cases, respectively. Whereas mRNA-1273 was used as for third dose in 91.2% of patients. At a median of 215 (IQR 181-252) days after booster dose, 40 (54.8%) patients displayed both AbR and CMI, 21 (28.8%) only AbR and 12 (16.4%) neither AbR or CMI; there were no patients showing negative AbR and positive CMI. Overall, 22 (30.1%) patients reported BI with no significant differences between those with positive vs. negative CMI (59.1% vs. 40.9%, p = 0.798), confirmed by multiple logistic regression after adjusting for age, type of vaccine and organs, high AbR and time from transplant.
CONCLUSION
Our data suggest that in the solid organ transplant population of our cohort, cell-mediated immunity does not appear to be a strong predictor of BI.
背景
实体器官移植（SOT）受者接种严重急性呼吸综合征冠状病毒2（SARS-CoV-2）疫苗后，抗体反应（AbR）欠佳，易发生突破性感染（BI）。细胞介导免疫（CMI）的作用仍不确定。
方法
对成年SOT受者进行单中心前瞻性纵向队列研究，在SARS-CoV-2疫苗加强剂量后6±2个月监测AbR和CMI。主要终点是BI诊断，CMI是主要危险因素。通过双变量检验和多变量逻辑回归研究CMI与BI之间的关系。
结果
对139例患者进行了CMI检测。66例患者在CMI检测前记录到BI，因此对73例（33例肾脏、24例肝脏、14例肺、2例心脏）进行了分析。前两剂疫苗分别为BNT162b2和mRNA-1273，分别占69.1%和30.9%的病例。而91.2%的患者第三剂使用mRNA-1273。在加强剂量后的中位215（IQR 181-252）天，40例（54.8%）患者同时出现AbR和CMI，21例（28.8%）仅出现AbR，12例（16.4%）既无AbR也无CMI；没有患者AbR阴性而CMI阳性。总体而言，22例（30.1%）患者报告发生BI，CMI阳性与阴性患者之间无显著差异（59.1%对40.9%，p = 0.798），在调整年龄、疫苗类型和器官、高AbR以及移植后的时间后，通过多变量逻辑回归得到证实。
结论
我们的数据表明，在我们队列的实体器官移植人群中，细胞介导免疫似乎不是BI的有力预测指标。
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