An Analysis of Serological Response and Infection Outcomes Following Oxford-AstraZeneca (AZD1222) and Pfizer-BioNTech (mRNA BNT162b2) SARS-CoV-2 Vaccines in Kidney and Kidney-pancreas Transplants.

Autor:	Asderakis A; Cardiff Transplant Unit, University Hospital of Wales, Cardiff, United Kingdom.; Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom., Khalid U; Cardiff Transplant Unit, University Hospital of Wales, Cardiff, United Kingdom.; Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom., Koimtzis G; Cardiff Transplant Unit, University Hospital of Wales, Cardiff, United Kingdom., Ponsford MJ; Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom.; Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, United Kingdom., Szabo L; Cardiff Transplant Unit, University Hospital of Wales, Cardiff, United Kingdom., Chalklin C; Cardiff Transplant Unit, University Hospital of Wales, Cardiff, United Kingdom., Bramhall K; Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, United Kingdom., Grant L; Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, United Kingdom., Moat SJ; Department of Medical Biochemistry, Immunology, and Toxicology, University Hospital of Wales, Cardiff, United Kingdom., Humphreys IR; Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom., Jolles SR; Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, United Kingdom.
Jazyk:	angličtina
Zdroj:	Transplantation [Transplantation] 2022 Jul 01; Vol. 106 (7), pp. 1421-1429. Date of Electronic Publication: 2022 Mar 08.
DOI:	10.1097/TP.0000000000004105
Abstrakt:	Background: Severe acute respiratory syndrome coronavirus 2 is associated with high mortality among transplant recipients. Comparative data that define humoral responses to the Oxford-AstraZeneca (AZ) and BNT162b2 (Pfizer-BioNTech) vaccines are limited. Methods: We recruited 920 kidney transplant patients receiving at least 1 dose of severe acute respiratory syndrome coronavirus 2 vaccine, excluding patients with virus pre-exposure. Serological status was determined with the COVID-SeroKlir ELISA (Kantaro-EKF Diagnostics). Patients with a corrected antibody level of <0.7 AU/mL were considered seronegative. Results: Four hundred ninety-five AZ and 141 Pfizer patients had a sample analyzed after first dose and 593 after second dose (346 AZ versus 247 Pfizer). After first dose, 25.7% of patients seroconverted (26.6% AZ, 22.8% Pfizer). After second dose, 148 (42.8%) of AZ seroconverted compared with 130 (52.6%) of Pfizer (P = 0.02; hazard ratio, 1.48; 95% confidence interval, 1.07-2.06). When negative responders were excluded, Pfizer patients were shown to have significantly higher response than AZ patients (median 2.6 versus 1.78 AU/mL, P = 0.005).Patients on mycophenolate had a reduced seroconversion rate (42.2% versus 61.4%; P < 0.001; hazard ratio, 2.17) and reduced antibody levels (0.47 versus 1.22 AU/mL, P = 0.001), and this effect was dose dependent (P = 0.05). Prednisolone reduced the seroconversion from 58.2% to 43.6% (P = 0.03) among Pfizer but not AZ recipients. Regression analysis showed that antibody levels were reduced by older age (P = 0.002), mycophenolate (P < 0.001), AZ vaccine (versus Pfizer, P = 0.001), and male gender (P = 0.02). Sixteen of 17 serious postvaccine infections occurred to patients who did not seroconvert. Conclusions: Both seroconversion and antibody levels are lower in AZ compared with Pfizer vaccinated recipients following 2 vaccine doses. Mycophenolate was associated with lower antibody responses in a dose-dependent manner. Serious postvaccine infections occurred among seronegative recipients. Competing Interests: A.A. has received grants from Sanofi (France) for work related to thymoglobulin and from Novartis (United Kingdom) as part of various trials. He also serves as a board member of Kidney Wales. S.R.J. reports advisory board, speaker, conference, drug safety monitoring board, and project support from CSL Behring, Shire, Takeda, BioCryst Pharmaceuticals, Swedish Orphan Biovitrum, Biotest, Binding Site, LFB, Octapharma, Grifols, UCB Pharma, Sanofi, Pharming, Weatherden, and Zarodex Therapeutics Limited. S.R.J. is a member of the International Patient Organisation for Primary Immunodeficiencies Supply and Access for Everyone (SAFE) Taskforce and COVID19 Trial Group. The other authors declare no conflicts of interest. (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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