The latest progress on novel coronavirus vaccination in kidney transplant recipients
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摘要: 肾移植受者由于长期服用免疫抑制药,免疫功能低下,感染新型冠状病毒后有更高的重症风险,对该高风险人群进行预防性接种疫苗至关重要。但有证据表明,肾移植受者对新型冠状病毒疫苗的免疫反应显著弱于健康人群,美国的标准接种方案如接种2针信使核糖核酸(mRNA)疫苗并不足以为肾移植受者提供足够的保护作用。已有多项研究证明增加肾移植受者疫苗接种的次数能够提高疫苗的效力,而调整免疫抑制治疗对提高疫苗效力的证据仍十分有限。本文就肾移植受者接种新型冠状病毒疫苗的重要性、有效性、特殊性以及免疫抑制治疗对新型冠状病毒疫苗效力影响进行综述,以期为肾移植受者的疫苗接种提供参考。Abstract: Due to long-term use of immunosuppressant, poor immune function and a higher risk of critical diseases after novel coronavirus pneumonia in kidney transplant recipients, it is of significance to deliver prophylactic vaccination for this high-risk population. Studies have shown that the immune reaction of kidney transplant recipients to novel coronavirus vaccine is significantly lower than that of healthy counterparts. Standard vaccination program in the United States, such as 2 doses of messenger RNA (mRNA) vaccine, fails to provide sufficient protection for kidney transplant recipients. Many studies have proven that increasing the frequency of vaccination for kidney transplant recipients may enhance the vaccine efficacy. Nevertheless, the role of adjusting immunosuppressive therapy in increasing vaccine efficacy remains to be elucidated. In this article, the importance, effectiveness and particularity of novel coronavirus vaccine for kidney transplant recipients and the effect of immunosuppressive therapy on the efficacy of novel coronavirus vaccine were reviewed, aiming to provide reference on the vaccination for kidney transplant recipients.
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表 1 未感染新型冠状病毒的器官移植受者接种2针或3针mRNA疫苗后血清学转换率
Table 1. Seroconversion of organ transplant recipients without previous novel coronavirus history after vaccinated with the 2nd or 3rd doses of mRNA vaccine
研究者 受者类型 例数(n) 疫苗接种次数 评估距最后一次接种的时间 血清学转换率①(%) 备注 Sattler A, et al[10] 肾移植 39 2针BNT162b2 8 d 2.5 S蛋白特异辅助T细胞反应较对照和透析人群显著降低,S蛋白特异CD8+T细胞反应几乎检测不到 Benning L, et al[12] 肾移植 135 2针BNT162b2或mRNA-1273或ChAdOx1 nCoV-19② 21 d 30 健康对照者的血清学转换率为100% Kamar N, et al[14] 实体器官移植肾移植 10178 3针BNT162b2 30 d 68 在59例第2针疫苗接种仍血清学阴性的受者中有26例(44%)在第3针疫苗接种后出现血清学转换 Benotmane I, et al[15] 肾移植 159 3针mRNA-1273 51 d 49 第2针疫苗接种后有微弱免疫反应的受者对第3针有反应的可能性高于第2针疫苗接种后无反应的受者(81.3%比27.4%) Hall VG, et al[16] 实体器官移植 120 3针mRNA-1273 30 d 55 随机对照试验,接种加强针组与安慰剂组的血清学转换率为55%比18% Massa F, et al[18] 肾移植 61 3针BNT162b2 28 d 62.3 接种第2针和第3针疫苗后的S蛋白特异的干扰素-γ释放细胞平均有19.9和64.0个/100万个外周血细胞 Rozen-Zvi B, et al[27] 肾移植 308 2针BNT162b2 2~4周 38.4 低剂量抗代谢药物、低血CNI浓度、不使用mTOR抑制剂与血清学转换相关 Chavarot N, et al[30] 肾移植 35 2针BNT162b2 28 d 5.7 均使用了贝拉西普 Benotmane I, et al[32] 肾移植 204 2针mRNA-1273 28 d 48 第1针疫苗接种后血清学阳性的受者接种第2针后有更高的抗体滴度 Grupper A, et al[33] 肾移植 136 2针BNT162b2 10~20 d 37.5 接种后症状与血清学转换无相关性 Marion O, et al[34] 实体器官移植肾移植 367271 2针BNT162b2 28 d 33 肝移植受者较其他器官受者有更好的体液免疫反应 Cucchiari D, et al[35] 肾移植 117 2针mRNA-1273 2周 29.9 65%的患者存在体液免疫反应或细胞免疫反应 Midtvedt K, et al[36] 肾移植 141 2针BNT162b2 25~89 d 18 受者年龄较大,中位数为75岁 Werbel WA, et al[37] 实体器官移植肾移植 3023 3针mRNA-1273或BNT162b2或ad26.COV2.S③ 14 d 46.6 15例受者第3针接种了ad26.COV2.S Stumpf J, et al[38] 肾移植 48 3针BNT162b2 30 d 40 26%的受者在接种3针疫苗后有细胞免疫反应 注:①血清学转换指接种疫苗后在血清中检测到抗S蛋白IgG。
②ChAdOx1 nCoV-19是由牛津大学和阿斯利康合作研发的一种腺病毒载体疫苗。
③ad26.COV2.S是强生公司研发的一种腺病毒载体疫苗。 -
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