Humoral and cellular immunity to SARS-CoV-2 vaccination in renal transplant versus dialysis patients: A prospective, multicenter observational study using mRNA-1273 or BNT162b2 mRNA vaccine

被引：238

作者：

Stumpf, Julian ^{[1
,40
]}

Siepmann, Torsten ^{[2
]}

Lindner, Tom ^{[3
]}

Karger, Claudia ^{[4
]}

Schwoebel, Joerg ^{[5
]}

Anders, Leona ^{[6
]}

Faulhaber-Walter, Robert ^{[7
]}

Schewe, Jens ^{[8
]}

Martin, Heike ^{[9
]}

Schirutschke, Holger ^{[10
]}

Barnett, Kerstin ^{[11
]}

Huether, Jan ^{[12
]}

Mueller, Petra ^{[13
]}

Langer, Torsten ^{[14
]}

Pluntke, Thilo ^{[15
]}

Anding-Rost, Kirsten ^{[16
]}

Meistring, Frank ^{[17
]}

Stehr, Thomas ^{[18
]}

Pietzonka, Annegret ^{[19
]}

Escher, Katja ^{[20
]}

Cerny, Simon ^{[21
]}

Rothe, Hansjorg ^{[22
]}

Pistrosch, Frank ^{[23
]}

Seidel, Harald ^{[24
]}

Paliege, Alexander ^{[1
]}

Beige, Joachim ^{[4
,25
]}

Bast, Ingolf ^{[6
]}

Steglich, Anne ^{[1
]}

Gembardt, Florian ^{[1
]}

Kessel, Friederike ^{[1
]}

Kroeger, Hannah ^{[1
]}

Arndt, Patrick ^{[1
]}

Sradnick, Jan ^{[1
]}

Frank, Kerstin ^{[26
]}

Klimova, Anna ^{[27
]}

Mauer, Rene ^{[28
]}

Graehlert, Xina ^{[29
]}

Anft, Moritz ^{[30
,31
]}

Blazquez-Navarro, Arturo ^{[30
,31
]}

Westhoff, Timm H. ^{[32
]}

Stervbo, Ulrik ^{[30
,31
]}

Tonn, Torsten ^{[33
,34
]}

Babel, Nina ^{[30
,31
,35
,36
,37
,38
,39
]}

Hugo, Christian ^{[1
,40
]}

机构：

[1] Tech Univ Dresden, Univ Klinikum Carl Gustav Carus, Med Klin & Poliklin 3, Dresden, Germany

[2] Krankenhaus Kuhwald, KfH Nierenzentrum, Klinikum Chemnitz, Dresden, Germany

[3] Univ Hosp Leipzig, Div Nephrol, Leipzig, Germany

[4] Klinikum St Georg, KfH Nierenzentrum, Leipzig, Germany

[5] Dialysezenturm Chemnitz, Chemnitz, Germany

[6] Dialysepraxis Leipzig, Leipzig, Germany

[7] Nephrol Zentrum Freiberg, Freiberg, Germany

[8] Dialyse & Nierenambulanz Sebnitz, Sebnitz, Germany

[9] Nephrol Zentrum Zwickau, Zwickau, Germany

[10] PHV Dialysezentrum Dresden Friedrichstadt, Dresden, Germany

[11] Dialyse Heidenau, Heidenau, Germany

[12] Nephrocare GmbH Dobeln, Dobeln, Germany

[13] PHV Dialysezentrum Dresden Johannstadt, Dresden, Germany

[14] Dialysezentrum Annaberg, Annaberg Buchholz, Germany

[15] KfH Nierenzentrum Grimma, Grimma, Germany

[16] KfH Nierenzentrum Bischofswerda, Bischofswerda, Germany

[17] Stadt Klinikum Gorlitz, KfH Nierenzentrum, Gorlitz, Germany

[18] KfH Nierenzentrum Bautzen, Bautzen, Germany

[19] Via Medis Nierenzentrum Dresden MVZ GmbH, Dresden, Germany

[20] KfH Gesundheitszentrum Aue, Aue Bad Schlema, Germany

[21] ELBLAND Dialyse Grossenhain, Grossenhain, Germany

[22] Dialyse Praxis Weiwasser, Weiwasser, Germany

[23] Nephrol Zentrum Hoyerswerda, Hoyerswerda, Germany

[24] Vogtland Krankenhaus Plauen, KfH Nierenzentrum, Plauen, Germany

[25] Martin Luther Univ Halle Wittenberg, Dept Nephrol & Rheumatol, Internal Med 2, Halle, Germany

[26] DRK Blutspendedienst Nord Ost Gemeinnutzige GmbH, Inst Transfus Med Plauen, Plauen, Germany

[27] Natl Ctr Tumor Dis NCT, Partner Site Dresden, Dresden, Germany

[28] Tech Univ, Fac Med Carl Gustav Carus, Inst Med Informat & Biometry IMB, Dresden, Germany

[29] Coordinating Ctr Clin Trials, Dresden, Germany

[30] Ruhr Univ Bochum, Ctr Translat Med, Med Dept 1, Marien Hosp Herne,Univ Hosp, Bochum, Germany

[31] Ruhr Univ Bochum, Univ Hosp, Marien Hosp Herne, Med Dept 1,Immune Diagnost Lab, Bochum, Germany

[32] Ruhr Univ Bochum, Marien Hosp Herne, Med Dept 1, Univ Hosp, Herne, Germany

[33] German Red Cross Blood Donat Serv North East, Inst Transfus Med, Dresden, Germany

[34] Tech Univ, Fac Med Carl Gustav Carus, Transfus Med, Dresden, Germany

[35] Charite Univ Med Berlin, Berlin Brandenburg Ctr Regenerat Therapies, Berlin, Germany

[36] Free Univ Berlin, Berlin, Germany

[37] Humboldt Univ, Berlin, Germany

[38] Berlin Inst Hlth, Berlin, Germany

[39] Inst Med Immunol, Berlin, Germany

[40] KfH Nierenzentrum Dresden, Dresden, Germany

来源：

LANCET REGIONAL HEALTH-EUROPE | 2021年 / 9卷

关键词：

epidemiology; COVID-19; SARS-CoV-2; vaccination; mRNA-1273; BNT162b2; tozinameran; dialysis patients; kidney transplant recipients; medical personnel; humoral and cellular immune response; clinical decision-making; guidelines; COVID-19; RECIPIENTS; SPIKE;

D O I：

10.1016/j.lanepe.2021.100178

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Background: Dialysis and kidney transplant patients are vulnerable populations for COVID-19 related disease and mortality. Methods: We conducted a prospective study exploring the eight week time course of specific cellular (interferon-g release assay and flow cytometry) or/and humoral immune responses (ELISA) to SARS-CoV-2 boost vaccination in more than 3100 participants including medical personnel, dialysis patients and kidney transplant recipients using mRNA vaccines BNT162b2 or mRNA-1273. Results: SARS-CoV-2-vaccination induced seroconversion efficacy in dialysis patients was similar to medical personnel (> 95%), but markedly impaired in kidney transplant recipients (42%). T-cellular immunity largely mimicked humoral results. Major risk factors of seroconversion failure were immunosuppressive drug number and type (belatacept, MMF-MPA, calcineurin-inhibitors) as well as vaccine type (BNT162b2 mRNA). Seroconversion rates induced by mRNA-1273 compared to BNT162b2 vaccine were 97% to 88% (p < 0.001) in dialysis and 49% to 26% in transplant patients, respectively. Specific IgG directed against the new binding domain of the spike protein (RDB) were significantly higher in dialysis patients vaccinated by mRNA-1273 (95%) compared to BNT162b2 (85%, p < 0.001). Vaccination appeared safe and highly effective demonstrating an almost complete lack of symptomatic COVID-19 disease after boost vaccination as well as ceased disease incidences during third pandemic wave in dialysis patients. Conclusion: Dialysis patients exhibit a remarkably high seroconversion rate of 95% after boost vaccination, while humoral response is impaired in the majority of transplant recipients. Immunosuppressive drug number and type as well as vaccine type (BNT162b2) are major determinants of seroconversion failure in both dialysis and transplant patients suggesting immune monitoring and adaption of vaccination protocols. (C) 2021 The Authors. Published by Elsevier Ltd.

引用

页数：11

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