Yon katriyèm vaksen SARS-CoV-2 MRNA nan moun k ap resevwa transplantasyon ren ki senpman seronegatif

Pou editè a:Transplantasyon ògàn solidbenefisyè yo te demontre yon pi ba repons iminitè umoral nan vaksen mRNA kowonaviris 2 (SARS-CoV-2) pou sendwòm respiratwa egi grav, ki mennen doktè transplantasyon yo fè yontwazyèm piki vaksen.1 Sepandan, malgre rapèl bonè sa a, apeprè 35% nan pasyan yo te rete seronegatif epi, kidonk, pa byen pwoteje kontmaladi kowonaviris2019 (COVID-19).2 Dènyèman, yon katriyèm piki mRNA te vin disponib an Frans, osi byen ke posiblite pou terapi antikò monoklonal prevantif chak mwa nan pasyan ki pa reponn oswa ki pa reponn.3,4 Sou baz doktè' ekspètiz ak pasyan yo' chwa,moun ki resevwa transplantasyon rensoti nan 2 lopital inivèsite franse ak yon evalyasyon serolojik estrikteman negatif (sa vle di, inite antikò obligatwa [BAU]<1/ml) 1 mwa apre twazyèm piki a te pwopoze pou resevwa yon katriyèm vaksen mRNA kòm yon altènativ a pre-exposition monoclonal antikò prophylaxis.

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Nou te evalye retrospektiv 49 moun ki pa reponntransplantasyon renbenefisyè ki gen yon evalyasyon serolojik apre yon katriyèm vaksen mRNA (Tablo 1). Mwayèn laj la te 63 ane, ak 47% se te gason. Okenn nan yo pa te gen yon istwa enfeksyon COVID-19 ni IgG anti-nucleocapsid. Terapi antretyen fèt nan inibitè calcineurin nan 77%, dwòg antiproliferatif nan 83%, ak estewoyid nan 57%. Yo tout te gen yon seroloji estrikteman negatif apre twazyèm piki a (BAU,<1/ml, evaluated in different laboratories by ECLIA Roche, Architect Abbott, or Diasorin). The serologic screening was assessed in a median of 35 days following the fourth injection, andanti-spike IgGtit yo te eksprime nan BAU/ml apre konvèsyon, tou depann de tès laboratwa a.

 A total of 21 of 49 patients (42.8%) seroconverted (i.e., positive serology considered by laboratory thresholds) following the fourth injection, with a mean BAU titer of 82/ml (Figure 1). Of note, 4 of them had a high BAU titer (>264/ml), which can be considered as neutralizing,5 and 3 patients without seroconversion had a slight increase in anti-spike IgG. SARS-CoV-2 infection occurred in 1 patient, who previously developed a low humoral response following 4 injections (BAU, 14.2/ml), presenting with mild symptoms and not requiring oxygen-supportive care. Although no statistical differences were found between responders and nonresponders because of the small analyzed cohort, we noted lower steroid use (47% vs. 64%), less lymphopenia (62% vs. 75%), longer time between the third and fourth dose (93 vs. 82 days), and a larger utilization of the BNT162b vaccine (86% vs. 68%) in patients who developed a humoral response after the fourth injection. History of biopsy-proven acute rejection seemed more frequent in seronegative patients. Still, the clinical significance of these data may be hard to assess as most cases in this group (4 of 6) occurred >5 ane de sa.

Rapò nou an mete aksan sou rezilta yon katriyèm vaksen mRNA nan moun k ap resevwa transplantasyon ren ki pa reponn entèdi, sa ki lakòz serokonvèsyon nan 43% nan yo. Se sèlman 4 pasyan ki te devlope yon repons umoral solid ki ka konsidere kòm pwoteksyon kont enfeksyon SARS-CoV-2; lòt pasyan yo ka benefisye de yon lòt dòz rapèl pou amelyore tit antikò yo.6 Yo mande plis etid pou detèmine klè faktè risk pou yo pa reponn apre yon katriyèm vaksen mRNA nan popilasyon sa a chwazi. Yon katriyèm vaksen mRNA nan moun k ap resevwa transplantasyon ren ki senpman ki pa reponn te pwovoke yon repons umoral nan 43%; sepandan, repons sa a te rete globalman fèb epi pwobableman pa t ase pwoteksyon kont COVID-19. Antikò monoklonal bay pi rapid ak pi wo pwoteksyon pou pasyan sa yo epi konsa yo ka konsidere, espesyalman pandan yonenfeksyon SARS-CoV-2 ki gen gwo ensidansperyòd lè arisk kontaminasyon an pi wo.

1. Hall VG, Ferreira VH, Ku T, et al. Esè owaza sou yon twazyèm dòz vaksen mRNA-1273 nan moun ki resevwa transplantasyon yo. N Engl J Med. 2021;385: 1244–1246.

2. Qin CX, Moore LW, Anjan S, et al. Risk pou gen enfeksyon SARS-CoV-2 nan moun ki resevwa transplantasyon adilt yo. Transplantasyon. 2021;105:e265–e266.

3. O'BrienMP, Forleo-Neto E, Musser BJ, et al. Konbinezon antikò REGEN-COV anba lar pou anpeche Covid-19. N Engl J Med. 2021;385:1184–1195.

4. Caillard S, Thaunat O. Vaksen COVID-19 nan moun k ap resevwa transplantasyon ren. Nat Rev Nephrol. 2021;17:785–787.

5. Feng S, Phillips DJ, White T, et al. Korelasyon pwoteksyon kont enfeksyon SARS-CoV-2 sentòm ak asymptomatik. Nat Med. 2021;27: 2032–2040.

6. Caillard S, Thaunat O, Benotmane I, et al. Repons antikò a yon katriyèm dòz vaksen RNA COVID-19 nan moun k ap resevwa transplantasyon ren: yon seri ka. Ann Entèn Med. Pibliye sou entènèt 11 janvye 2022 https://doi. org/10.7326/L21-0598