Iminojenisite vaksen COVID-19 nan moun k ap resevwa transplantasyon ògàn solid: yon revizyon sistematik ak meta-analiz

abstrè

Jan nou koumanse: Moun ki resevwa transplantasyon ògàn solid (SOT) yo gen plis risk pou yo morbidite ak mòtalite ki asosye ak COVID-19.

Objektif: Etid sa a te vize evalye iminojenisite vaksen COVID-19 nan moun k ap resevwa SOT yo.

Sous done yo: Yo te fouye nan baz done elektwonik pou rapò elijib ki te pibliye soti 1 Desanm 2019 rive 31 Me 2022.

Kritè kalifikasyon etid:Nou te enkli rapò ki evalye repons iminitè umoral (HIR) oswa to repons iminitè selilè nan moun k ap resevwa SOT apre yo te administre vaksen COVID-19. Patisipan yo: Moun k ap resevwa SOT ki te resevwa vaksen COVID-19.

Evalyasyon risk pou patipri: Nou te itilize echèl Newcastle-Ottawa pou evalye patipri nan ka-kontwòl ak etid kòwòt. Pou esè kontwole owaza, yo te itilize Echèl Jadad la.

Metòd: Nou itilize yon modèl efè o aza pou kalkile pousantaj repons iminitè yo ak 95% CI. Nou itilize yon rapò risk (RR) ak 95% CI pou yon konparezon nan repons iminitè ant SOT ak kontwòl ki an sante.

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Rezilta yo: Yon total de 91 rapò ki enplike 11 886 moun k ap resevwa transplantasyon (poumon: 655; kè: 539; fwa: 1946; ak ren: 8746) ak 2125 kontwòl sante yo te revele pousantaj HIR yo mete apre 1ye, 2yèm, ak 3yèm COVID{{ 10}} dòz vaksen nan moun k ap resevwa SOT yo te 9.5% (95% CI, 7e11.9%), 43.6% (95% CI, 39.3e47.8%) ak 55.1% (95% CI, 44.7e65.6%), respektivman. Pou ògàn espesifik, pousantaj HIR yo te toujou ba apre premye dòz vaksen (poumon: 4.4%; ren: 9.4%; kè: 13.2%; fwa: 29.5%) ak 2yèm dòz vaksen (poumon: 28.4%; ren: 37.6%; kè: 50.3%; fwa: 64.5%).

Entwodiksyon

COVID-19 ogmante siyifikativman risk maladi grav ak lanmò nan moun k ap resevwa transplantasyon ògàn solid (SOT) akòz iminodepresyon ki kache ak komorbidite koncomitan [1]. Pousantaj entène lopital ak mòtalite COVID-19 varye ant 26% a 63% [2,3] ak 13% a 30% [4] nan moun k ap resevwa SOT yo, respektivman. Yo detèmine vaksen COVID-19 se fason ki pi efikas pou kontwole pandemi an [5,6]. Rive jiyè 2022, plis pase 10 milya dòz vaksen yo te administre atravè lemond. Iminogenisite vaksen COVID-19 te byen demontre nan popilasyon jeneral la nan gwo echèl faz III esè [7e9]. Malerezman, premye esè pou vaksen sa yo pa t enkli moun k ap resevwa SOT yo. Etid resan yo te demontre repons iminitè redwi nan moun ki resevwa transplantasyon, sepandan, rezilta pami etid yo varye anpil [10e13]. Se poutèt sa, li nesesè pou entegre rezilta sa yo pou pi byen konprann iminojenisite vaksen COVID-19 nan popilasyon sa yo. Objektif meta-analiz sa a se te evalye iminojenisite vaksen COVID-19 nan moun k ap resevwa SOT.

Metòd

Apèsi sou lekòl la

Revizyon sistematik sa a ak meta-analiz te fèt lè l sèvi avèk Meta-analiz yo nan Etid Obsèvasyon nan Epidemyoloji [14] direktiv yo. Rapò sa a te pre-anrejistre epi soumèt bay PROSPERO (CRD42022311886).

Sous done ak rechèch

Nou te fè yon rechèch nan baz done elektwonik (PubMed, Web of Science, Cochrane Library, ak Embase) soti 1 Desanm 2019 rive 31 Me 2022. Detay estrateji rechèch yo montre nan Tablo S1. Yo te idantifye tèm sa yo: 'COVID-19', 'SARS-CoV-2', 'vaksen', 'vaksen', 'transplantasyon ògàn solid', 'transplantasyon', 'grèf fwa (LIT) ', 'grèf ren (KT)', 'grèf kè (HT)', 'grèf poumon (LUT)', 'grèf pankreyas', 'iminojenisite', 'serokonvèsyon', 'repons iminitè umoral (HIR)', ak ' repons iminitè selilè (CIR)'. De evalyatè yo te fè rechèch la poukont yo, epi yon twazyèm evalyatè te rezoud dezakò.

seleksyon etid

Atik yo te enkli kèlkeswa fòma piblikasyon an (papye orijinal, kòmantè, rezime, ak lèt). Pa te gen okenn restriksyon lang. Nou enkli rapò ki evalye omwen youn nan rezilta kle yo. Rapò ki gen mwens pase 10 pasyan yo te eskli.

Rezilta enterè yo

Rezilta prensipal etid sa a enkli pousantaj HIR pami moun k ap resevwa SOT yo ak konparezon HIR ant moun k ap resevwa SOT ak kontwòl ki an sante yo. Rezilta segondè yo enkli pousantaj CIR ak konparezon CIR ant moun ki nan SOT ak kontwòl ki an sante.

Ekstraksyon done ak evalyasyon kalite

Nou analize tout etid ki kalifye yo pou nou retire detay sou premye otè a, ane piblikasyon an, konsepsyon etid, sèks, laj, gwosè echantiyon, kalite vaksen, kalite ògàn, kantite dòz yo administre, tan apre transplantasyon an, mezi iminojenisite, entèval tan ant 2yèm ak 3yèm dòz la, ak rezilta enterè yo. Nou kontakte otè yo pou done ki manke yo. Yo te itilize echèl Newcastle-Ottawa [15] nan etid ka kontwòl, ki te apwopriye tou pou etid kòwòt yo. Pou esè ki kontwole owaza yo (RCTs), yo te itilize Echèl Jadad [16]. Echèl Newcastle-Ottawa varye ant 0 ak 9, ak echèl Jadad la varye ant 0 ak 5, ak pi gwo nòt ki endike yon risk redwi patipri. Klas Rekòmandasyon, Evalyasyon, Devlopman, ak Evalyasyon (GRADE) [17] te fèt pou evalye fyab prèv pou rezilta enterè yo.

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Done sentèz ak analiz

We used Stata version 12.0 to perform the meta-analysis. The random-effects model was used to estimate the pooled rates with 95% CI of immune response after the COVID-19 vaccine in SOT recipients. We used a risk ratio (RR) with 95% CI for a comparison of immune responses between SOT and healthy controls. We calculated pooled rates and RR using the 'meta prop' and 'mean' commands in Stata software, respectively. Heterogeneity was defined as mild (I2 ¼ 0e25%), moderate (I2 ¼ 26e75%), or considerable (I2 >75%). Yo te fè analiz sansiblite lè yo retire yon etid nan yon moman pou konfime solidite rezilta yo [18]. Analiz sou gwoup yo te fèt dapre kalite ògàn, kalite vaksen, tan apre transplantasyon, entèval tan ant 2yèm ak 3yèm dòz la, ak dòz vaksen an (yon sèl, de oswa twa dòz). Nou pa t fè analiz sougwoup si kantite rapò ki enkli yo te mwens pase senk. Yo te fè yon analiz meta-regresyon efè melanje pou evalye sous ak grandè eterojenite. Varyab depandan an ka modere pa varyab sa yo: (a) kalite vaksen, (b) tan apre transplantasyon, (c) kalite etid, ak (d) gwosè echantiyon etid la. Si kantite etid enkli yo te plis pase dis, yo te fè yon evalyasyon patipri piblikasyon lè l sèvi avèk tès Egger ak simit antonwa.

Rezilta yo

Karakteristik etid enkli Rechèch baz done elektwonik nou an te idantifye 2073 atik. Yo te idantifye 150 yon sèl atik potansyèlman enpòtan pou evalyasyon konplè tèks apre yo fin retire atik kopi epi evalye rezime ak tit (figi 1). Apre w fin aplike kritè kalifikasyon yo, 91 [5,6,10-13,19-25,26-35,36-45,46-55,56-65,{{ 13}},76- 85,86-95,96-103] atik yo te enkli nan sentèz quantitative a, de ki te RCTs. Meta-analiz sa a te enplike yon total de 11 886 resevwa transplantasyon (LUT: 655, HT: 539, LIT: 1946, ak KT: 8746) ak 2125 kontwòl ki an sante. Detay yo nan etid enkli yo montre nan Tablo 1.

HIR nan SOT benefisyè yo

Vennkat etid [13,24,27,28,33,40,43,46,47,49,53,55,58,63, 64,74e76,81,90 e92,95,103] te evalye HIR apre administrasyon premye dòz vaksen an nan moun k ap resevwa SOT yo. Pousantaj repons pisin lan te 9.5% (95% CI, 7e11.9%) (Fig. 2a) ak eterojenite konsiderab (I2 ¼ 89.1%; p <0.001). Analiz sansiblite endike ke rezilta a pa te chanje ansibleman (figi S1a). Swasannkenz etid [5,6,10-13,20,21,23,25-27,29-31,34-39,41- 48,50-53 ,55,56,58-64,66-75,77-84,86-95,97-100] te evalye HIR apre 2yèm dòz vaksen an nan moun k ap resevwa SOT yo. Pousantaj repons pisin lan te 43.6% (95% CI, 39.3e47.8%) (Fig. 2b) ak eterojenite konsiderab (I2 ¼ 95.4%; p <0.001). Analiz sansiblite pa t 'chanje rezilta a (Fig. S1b). Disèt etid [19,20,23,32,43,54,64,67,69,72e74,80,96,99, 101,102] te evalye HIR apre administrasyon 3yèm dòz vaksen nan moun k ap resevwa SOT yo, ki gen 55,1% ( 95% CI, 44.7e65.6%) (Fig. 2c) montre yon repons umoral, ak eterojenite konsiderab (I2 ¼ 95.2%; p <0.001). Analiz sansiblite revele ke pousantaj HIR la te 60% (95% CI, 55.1e64.9%; I2 ¼ 69.9%; p <0.001) (Fig. S1c) apre yo fin retire etid la pa Chavarot et al. [32].

Konparezon HIR (benefisyè SOT kont kontwòl ki an sante)

Kat etid [22,40,91,95] konpare HIR ant moun k ap resevwa SOT ak kontwòl ki an sante apre premye dòz vaksen an. Tout etid enkli yo te itilize vaksen mRNA. Rezilta a te demontre ke moun k ap resevwa SOT yo te gen yon pousantaj HIR siyifikativman pi ba pase kontwòl ki an sante (RR ¼ 0.{{10}}36; 95% CI, 0.{{8 0}}14e0.091; I2 ¼ 55.9%, p ¼ 0.078) (Fig. 2d). Analiz sansiblite pa t chanje rezilta a (figi S1d). Vennèf etid [1,4,5,17,21,25,32,34,37,38,42,44,47e49, 54,56,65,66,68,73,84e86, 88,90,92,94,98] te konpare HIR pami moun k ap resevwa SOT ak kontwòl ki an sante apre 2yèm dòz vaksen an. Sèlman vennsenk etid [1,4,5,17,21,32,34,37,38,44,47,48,54,56,65,66,68, 73,84e86,88 ,92,94,98] te itilize vaksen mRNA a, yon etid [25] te itilize sèlman vaksen inaktive, de [49,90] te itilize mRNA oswa vaksen vektè adenoviris, epi youn [42] te itilize vaksen mRNA oswa inaktive. Rezilta a te demontre ke moun k ap resevwa SOT yo te montre yon pousantaj HIR siyifikativman pi ba pase kontwòl ki an sante (RR ¼ 0.382; 95% CI, 0.313e0.468; I2 ¼ 96.1%, p <0.001) (Fig. 2e). Analiz sansiblite pa t chanje rezilta a (figi S1e).

CIR nan benefisyè SOT yo

Sis etid [27,33,47,53,90,95] te evalye CIR apre premye dòz vaksen an nan moun k ap resevwa SOT yo. Senk etid [27,33,47,53,95] te itilize vaksen mRNA, ak yon etid [90] te itilize vaksen vektè mRNA oswa adenovirus. Pwopòsyon an jeneral nan benefisyè SOT ki te ekspoze CIR te 12.2% (95% CI, 6.5e17.8%, Fig. 3a), ak eterojenite modere (I2 ¼ 60.5%, p ¼ 0.027). Analiz sansiblite pa t 'chanje rezilta a (Fig. S2a).

Fig. 1. Dyagram koule nan pwosesis seleksyon etid la.

Tablo 1 Karakteristik etid enkli nan revizyon sistematik ak meta-analiz repons iminitè a vaksen COVID-19 nan moun k ap resevwa SOT

Tablo 1 (kontinye)

Tablo 1 (kontinye)

Dizwit etid [6,27,29,33,38,39,44,47,53,57,58,78,79,87, 89,90,95,102] evalye CIR la apre 2yèm dòz vaksen an nan moun k ap resevwa SOT yo. Kenz etid [6,27,33,38,39,44,47,53,57,58,78,79, 89,95,102] te itilize vaksen mRNA, youn [30] te itilize vaksen inaktive, ak de [87,90] te itilize mRNA oswa vaksen vektè adenovirus. Pwopòsyon an jeneral nan benefisyè SOT ki ekspoze CIR te 48.3% (95% CI, 34.2e62.4%, Fig. 3b) ak eterojenite konsiderab (I2 ¼ 96.5%, p <0.01). Analiz sansiblite pa t 'chanje rezilta a (Fig. S2b). Se sèlman de etid [96,102] rapòte CIR la apre 3yèm dòz vaksen an nan moun k ap resevwa SOT (Fig. 3c). Pwopòsyon an jeneral nan moun k ap resevwa SOT ki montre CIR ak eterojenite konsiderab (I2 ¼ 96.5%, p <0.001) te 57.6% (95% CI, 5.4% a 120.6%).

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Konparezon CIR (benefisyè SOT kont kontwòl ki an sante)

Senk etid [29,38,47,87,89] konpare benefisyè SOT yo ak kontwòl ki an sante apre 2yèm dòz vaksen an (figi 3d). Rezilta metaanaliz la te revele ke moun k ap resevwa SOT yo te gen yon pousantaj CIR siyifikativman pi ba pase kontwòl sante yo (RR ¼ 0.477; 95% CI, 0.257-0.885; I2 ¼ 96.9%, p < 0.001). Analiz sansiblite pa t chanje rezilta a (figi S2c).

Analiz sougwoup ki baze sou kalite ògàn pou HIR

Jan yo montre nan Fig. 4a ak Tablo 2, sèz etid [13,24,27,28,33,40,46,49,74e76,81,95,103] te evalye HIR apre premye dòz vaksen an nan moun k ap resevwa KT. Pousantaj nan pisin te 9.4% (95% CI, 6e12.7%), ak eterojenite konsiderab (I2 ¼ 9{{101}}.9%, p <0.{{125 }}01). Analiz sansiblite pa t 'chanje rezilta a (figi S3a). Karannde etid [5,10,11,13,21,23,25,27,29,30,35,37,39,42, 44,48,5{{ 198}},53,56,59,62,66,68,7{{207}}e75,77,80e82,86,88,89, 95,99,100] te evalye HIR apre 2yèm dòz la nan moun k ap resevwa KT yo. Pwopòsyon an jeneral nan moun k ap resevwa KT ki montre HIR te 37.6% (95% CI, 33.5e41.6%; I2 ¼ 90.5%, p <0.001). Analiz sansiblite pa t 'chanje rezilta a (Fig. S3b). Sèlman 13 etid [19,23,32,43,64,72e74,80,96,99,101,102] te evalye HIR apre 3yèm dòz vaksen an nan moun k ap resevwa KT, yo te montre 54.4% (95% CI, 40.8e68.1%). yon repons umoral, ak eterojenite konsiderab (I2 ¼ 96.3%, p <0.001). Analiz sansiblite pa t chanje rezilta a (figi S3c). Pwopòsyon an jeneral nan moun k ap resevwa LIT ki te montre HIR apre premye dòz vaksen an te 29.5% (95% CI, 12.2e46.7%), ak eterojenite konsiderab (I2 ¼ 86.5%, p <0.001). Analiz sansiblite endike ke pousantaj repons pisin lan te 37% (95% CI, 29.1e44.8%) san eterojenite (I2 ¼ 0, p ¼ 0.951), apre yo fin retire etid la pa Mazzola et al. [13] (figi S3d). Disèt etid [5,10,13,34,41,46,47,51,53,58,60,61,71,84,87,94,97,98] te evalye HIR apre 2yèm dòz vaksen an nan LIT. Pousantaj repons lan te 64.5% (95% CI, 57.4e71.6%; I2 ¼ 89.5%, p <0.01). Analiz sansiblite pa t chanje rezilta a (figi S3e). Kat etid [13,28,58,63] evalye HIR apre premye dòz vaksen an nan HT. Tout etid yo te itilize vaksen RNA. Pousantaj repons pisin lan te 13.2% (95% CI, 8.1e18.2%) san eterojenite (I2 ¼ 0, p ¼ 0.934). Onz etid [10,13,31,53,55,58,61,63,70,83,93] te evalye HIR apre 2yèm dòz vaksen an nan moun k ap resevwa HT, 50.3% yo te montre yon repons umoral (95% CI, 37.6e63%) ak eterojenite konsiderab (I2 ¼ 89.1%, p <0.001). Analiz sansiblite pa t chanje rezilta a (Fig. S3f). Se sèlman de etid [28,92] detekte HIR a apre premye dòz vaksen an nan pasyan LUT yo. Pousantaj repons pisin lan te 4.4% (95% CI, 0.9e7.9%, I2¼17.7%). Uit etid [10,12,31,53,55,61,79,92] te evalye HIR apre 2yèm dòz vaksen an nan moun k ap resevwa LUT yo, 28.4% (95% CI, 22.3e34.5%), te montre yon repons ak konsiderab eterojenite (I2 ¼ 64.5%, p <0.001). Analiz sansiblite revele ke pwopòsyon an jeneral nan HIR te 30.8% (95% CI, 26.2e35.3%; I2 ¼12.5; p ¼ 0.335) (Fig. S3G), apre yo fin retire etid la pa Shostak et al. [92].

Fig. 2. Meta-analiz HIR apre 1ye, 2yèm, ak 3yèm dòz vaksen COVID-19 nan moun k ap resevwa SOT ak konparezon HIR. (A) HIR apre 1ye dòz vaksen nan SOT (9.5%); (B) HIR apre 2yèm dòz vaksen nan SOT (43.6%); (C) HIR apre 3yèm dòz vaksen nan SOT (55.1%); (D) Konparezon HIR apre 1ye dòz vaksen (SOT kont kontwòl sante, RR ¼ 0.036); (E) Konparezon HIR apre 2yèm dòz vaksen (SOT kont kontwòl ki an sante, RR ¼ 0.382). HIR, repons iminitè umoral; SOT, transplantasyon ògàn solid; RR, rapò risk.

Analiz sougwoup ki baze sou kalite ògàn pou CIR

Jan yo montre nan Figi 4b ak Tablo 2, sèlman de etid enkli [33,95] rapòte CIR la apre 1ye dòz vaksen nan moun k ap resevwa KT. Pwopòsyon jeneral moun k ap resevwa KT ki te montre CIR te 6.9% (95% CI, 3.1e10.7%) san etewojenite (I2 ¼ 0, p ¼ 0.51). Onz etid [6,27,29,33,38,39,44,47,89,95,102] te evalye CIR apre 2yèm dòz vaksen an nan moun k ap resevwa KT yo. Dis etid [6,27,33,38,39,44,47,89,95,102] te itilize yon vaksen mRNA ak youn [29] te itilize yon vaksen inaktive. Pwopòsyon an jeneral nan moun k ap resevwa KT ki montre CIR te 42.6% (95% CI, 23.5e61.7%) ak eterojenite konsiderab (I2 ¼ 97.0%, p <0.001). Analiz sansiblite pa t 'chanje rezilta a (figi S3h).

Fig. 3. Meta-analiz CIR apre 1ye, 2yèm, ak 3yèm dòz vaksen COVID-19 nan moun k ap resevwa SOT yo. (A) CIR apre 1ye dòz nan SOT (12.2%); (B) CIR apre 2yèm dòz nan SOT (48.3%); (C) CIR apre 3yèm dòz nan SOT (57.6%); (D) Konparezon CIR apre 2yèm dòz (SOT kont kontwòl ki an sante, RR ¼ 0.477). CIR, repons iminitè selilè; SOT, transplantasyon ògàn solid; RR, rapò risk.

Twa etid [47,58,87] te evalye CIR apre 2yèm dòz vaksen an nan moun k ap resevwa LIT yo. De etid [47,58] te itilize vaksen mRNA, e youn [87] te itilize vaksen vektè mRNA oswa adenovirus. Pwopòsyon an jeneral nan moun k ap resevwa LIT ki te revele yon pousantaj CIR te 66.3% (95% CI, 30.1e1{02.5%) ak eterojenite konsiderab (I2 ¼ 96.1%, p <{{27} }.001). Analiz sansiblite te montre ke pousantaj repons pisin lan te 85% (95% CI, 76.7e93.3%) san eterojenite (I2 ¼ 0, p ¼ 0.459) apre yo fin retire etid la pa Ruether et al. [87]. Se sèlman de etid [57,79] ki te evalye CIR apre 2yèm dòz vaksen an nan moun k ap resevwa LUT yo. Pwopòsyon an jeneral nan moun k ap resevwa LUT ak eterojenite segondè (I2 ¼ 88.9%, p <0.001) te 56.9% (95 CI% ¼ 14.5e99.2%).

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Analiz sougwoup ki baze sou kalite ògàn: konparezon HIR (resipyan transplantasyon vs kontwòl sante)

Jan yo montre nan Tablo 2, sèlman 3 etid [22,40,95] konpare HIR a pami moun k ap resevwa KT ak kontwòl ki an sante apre premye dòz vaksen an. Rezilta a te revele ke konpare ak kontwòl ki an sante, moun k ap resevwa KT yo te gen yon pousantaj HIR siyifikativman pi ba (RR ¼ 0.030; 95% CI, 0.{ {35}}07e0.124; I2 ¼ 75%, p ¼ 0.018). Analiz sansiblite pa t 'chanje rezilta a ansibleman (Fig. S4a). Apre 2yèm dòz vaksen an, 12 etid [29,38,42,48, 50,59,66,68,82,85,89,95] te montre ke moun k ap resevwa KT yo te gen yon pousantaj HIR siyifikativman pi ba pase. kontwòl yo an sante, (RR ¼ 0.322; 95% CI, 0.242e0.429; I2 ¼ 90.7%, p <0.001). Analiz sansiblite pa t 'chanje rezilta a ansibleman (Fig. S4b). Sèt etid [5,13,41,46,51,84,87] te montre ke moun k ap resevwa LIT yo te montre pousantaj HIR siyifikativman pi ba pase kontwòl sante yo (RR ¼ 0.676; 95% CI, 0.589e0.776; I2 ¼ 83.7%, p. <0.001). Analiz sansiblite pa t 'chanje rezilta a ansibleman (Fig. S4c).

Analiz sougwoup ki baze sou kalite ògàn: konparezon CIR (resipyan transplantasyon vs kontwòl sante)

Jan yo montre nan Tablo 2, twa etid [29,38,89] konpare CIR ant moun k ap resevwa KT ak kontwòl ki an sante apre 2yèm dòz vaksen an. Rezilta yo te montre ke moun k ap resevwa KT yo te montre yon pousantaj CIR siyifikativman pi ba pase kontwòl sante yo (RR ¼ 0.416; 95% CI, 0.416e1.22{0; I2 ¼ 98.1% , p <0.001). Analiz sansiblite pa t 'chanje rezilta a ansibleman (Fig. S4d).

Analiz sougwoup ki baze sou kalite vaksen nan moun k ap resevwa SOT yo

Jan yo montre nan Tablo 2, analiz sougwoup yo te revele ke pousantaj HIR pisin vaksen mRNA a te 7.9% (95% CI, 5.7e10.1%; I2 ¼ 85.2%), 42.2% (95% CI, 37.6e46.9%; I2 ¼ 95.2%) ak 56.2% (95% CI, 44.5e67.9%; I2 ¼ 95.8%) apre administrasyon an nan 1ye, 2yèm, ak 3yèm dòz vaksen, respektivman. Sepandan, pousantaj HIR ansanm vaksen inaktive a te sèlman 24.8% (95% CI, 3.5e46.1%; I2 ¼ 96.3%) apre administrasyon 2yèm dòz vaksen an nan moun k ap resevwa SOT yo. Analiz sougwoup te revele ke pousantaj CIR vaksen mRNA yo te 12.2% (95% CI, 5.7e18.8%; I2 ¼ 67.4%) ak 51.6% (95% CI, 39e64.2%; I2 ¼ 93.8%) apre administrasyon an. nan 1ye ak 2yèm dòz vaksen, respektivman.

Fig. 4. Meta-analiz HIR ak CIR apre 1ye, 2yèm, ak 3yèm dòz vaksen COVID-19 nan diferan kalite moun k ap resevwa transplantasyon. (A) HIR nan LUT (1ye dòz: 4,4%, 2yèm dòz: 28,4%), HT (1ye dòz: 13,2%, 2yèm dòz: 50,3%), LIT (1ye dòz: 29,5%, 2yèm dòz: 64,5%) ak KT (1ye dòz: 9.4%, 2yèm dòz: 37.6%, 3yèm dòz: 54.4%); (B) CIR nan LIT (2yèm dòz: 66.3%) ak KT (1yèm dòz: 6.9%, 2yèm dòz: 42.6%, 3yèm dòz: 57.6%). HIR, repons iminitè umoral; CIR, repons iminitè selilè; KT, transplantasyon ren; LIT, transplantasyon fwa; HT, transplantasyon kè; LUT, transplantasyon poumon.

Analiz sougwoup yo te revele ke moun k ap resevwa SOT ki te resevwa sèlman vaksen mRNA te gen yon pousantaj HIR siyifikativman pi ba pase kontwòl sante yo (RR ¼ {{0}}.366; 95% CI, 0.291e{{ 9}}.461; I2 ¼ 96.0%). Analiz sansiblite te montre ke tout rezilta yo nan analiz sougwoup sa a pa te chanje ansibleman.

Analiz sougwoup tan apre transplantasyon nan moun k ap resevwa SOT yo

As shown in Table 2, subgroup analysis revealed that the pooled HIR rates of time post-transplant  5 years were 5.2% (95% CI, 2.5e7.8%; I2 ¼ 53.2%), 33.3% (95% CI, 28.1e38.5%; I2 ¼ 80.6%) and 51.2% (95% CI, 30.6e71.8%; I2 ¼ 95.7%) after the administration of 1st, 2nd, and 3rd vaccine doses, respectively. In contrast, the pooled HIR rates of time post-transplant >5 years were 11.2% (95% CI, 7.9e14.4%; I2 ¼ 89.1%), 45.0% (95% CI, 39.4e50.5%; I2 ¼ 95.9%) and 58.6% (95% CI, 48.6e68.7%; I2 ¼ 85%) after the administration of 1st, 2nd, and 3rd vaccine doses, respectively. Subgroup analysis revealed that the pooled CIR rates of time post-transplant  5 years were 11.5% (95% CI, 2.0e21.1%; I2 ¼ 68.1%) and 44.5% (95% CI, 21.1e68.0%; I2 ¼ 93.8%) after receiving the 1st and 2nd vaccine doses, respectively. The rates of time posttransplant >5 ane yo te 13.7% (95% CI, 4.4e23.0%; I2 ¼ 68.1%) ak 51.2% (95% CI, 32.0e70.4%; I2 ¼ 93.8%) apre yo fin resevwa 1ye ak 2yèm dòz vaksen an, respektivman. Analiz sansiblite pa t chanje rezilta a nan analiz sougwoup tan apre transplantasyon an.

Tablo 2 analiz sougwoup ki baze sou kalite vaksen an, kalite ògàn, ak tan apre transplantasyon an

Tablo 3 analiz sougwoup ki baze sou kalite vaksen an ak tan apre transplantasyon nan diferan kalite transplantasyon

Analiz sougwoup ki baze sou kalite vaksen nan diferan kalite transplantasyon pou HIR

Jan yo montre nan Tablo 3, pousantaj HIR rezime vaksen mRNA a te 6.6% (95% CI, 3.8e9.4%; I2 ¼ 85.3%), 37.6% (95% CI, 33.2e42%; I 2 ¼ 89.8%), ak 55.5% (95% CI, 41.2e69.8%; I2 ¼ 96.6%) apre yo fin resevwa 1ye, 2yèm, ak 3yèm dòz vaksen an, respektivman, nan moun k ap resevwa KT. Anplis de sa, pousantaj HIR pou vaksen inaktive yo te 24.8% (95% CI, 3.5e46.1%; I2 ¼ 96.3) apre administrasyon 2yèm dòz vaksen an nan moun k ap resevwa KT. Pousantaj HIR rezime vaksen mRNA a te 37% (95% CI, 29.1e44.8%; I2 ¼ 0%) ak 60.7% (95% CI, 51.9e69.5%; I2 ¼ 90.9%) apre a. administrasyon 1ye ak 2yèm dòz vaksen nan moun k ap resevwa LIT, respektivman. Pousantaj HIR ansanm vaksen mRNA a te 48.1% (95% CI ¼ 34.7%e61.4%, I2 ¼ 89.1%) apre administrasyon 2yèm dòz vaksen an nan moun k ap resevwa HT.

Analiz sou gwoup ki baze sou kalite vaksen nan diferan kalite transplantasyon pou CIR

Pousantaj CIR rezime vaksen mRNA a te 46.7% (95% CI, 30.3e63.2%; I2 ¼ 94.6%) ak 85% (95% CI, 76.7e93.3%, I2 ¼ 0%) apre administrasyon an nan 2yèm dòz nan moun k ap resevwa KT ak LIT, respektivman (Tablo 3).

Analiz sougwoup ki baze sou tan apre transplantasyon nan diferan kalite transplantasyon

Jan yo montre nan Tablo 3, ak tan ki te ogmante apre transplantasyon an, pousantaj HIR ak CIR yo te wo anpil nan diferan moun ki resevwa transplantasyon ògàn apre yo te administre 1ye, 2yèm ak 3yèm dòz.

Analiz sougwoup ki baze sou entèval tan ant 2yèm ak 3yèm dòz vaksen an nan moun k ap resevwa SOT ak KT.

Analiz sougwoup la te fèt dapre entèval tan ant administrasyon 2yèm ak 3yèm dòz. Anplis, rezilta a te montre ke pousantaj HIR yo pa t chanje siyifikativman tou de nan SOT ak KT moun k ap resevwa (Fig. S5).

Klase kalite prèv la

Apwòch GRADE te endike bon jan kalite jeneral prèv la te ba paske pifò done yo te soti nan etid obsèvasyon (Tablo S2).

Analiz meta-regresyon

Analiz meta-regresyon endike ke eterojenite HIR apre 1ye ak 2yèm dòz yo soti nan kalite vaksen an ak tan apre transplantasyon an, respektivman (Tablo S3). Gwosè echantiyon ak nòt risk-nan-patipri nan nivo etid la pa t 'montre modifikatè efè enpòtan nan analiz meta-regression.

Benefis cistanche tubulosa-ranfòse sistèm iminitè

Patipri piblikasyon

Yo te detèmine patipri piblikasyon atravè gwosè efè konplo antonwa. Pa gen okenn patipri piblikasyon yo te jwenn nan rezilta prensipal yo (Fig. S6).

Diskisyon

This systematic review and meta-analysis summarised the cumulative evidence of immunogenicity of the COVID-19 vaccines in SOT recipients. We demonstrated that the immunogenicity of the vaccine was poor in SOT, especially for LUT recipients, varied among target organs, and was significantly lower than that of healthy controls. A booster vaccination could induce a stronger immune response. Besides, the longer the time post-transplant was, the higher the probability of a detectable HIR and CIR after the vaccination in SOT recipients. Moreover, the immunogenicity of mRNA-based vaccines was stronger than the inactivated vaccines in SOT recipients. Our meta-analysis showed that the immunogenicity of COVID-19 vaccines in cellular or humoral immune responses was signifi- cantly impaired in SOT patients. However, with an increased vaccination dose, SOT patients' immune capacity can be enhanced, consistent with previous studies [64,67,69,74]. In our analysis, we found that, after receiving the 2nd dose, SOT patients' immune response rate significantly increased from 9.5% to 43.6% in HIR, and from 12.2% to 48.3% in CIR. In addition, the rates of HIR and CIR reached 56.2% and 57.6% after receiving the 3rd vaccine dose, respectively. The same trend was observed in different transplant recipients. The HIR rates after the 2nd vaccine dose increased from 4.4% to 28.4% in LUT recipients and from 13.2% to 50.3% in HT recipients. A higher proportion of LIT and KT recipients exhibited a humoral response after the 2nd vaccine dose. Although vaccine immunogenicity in SOT patients improved with an increased dose, immune response varied among different transplant recipients. Therefore, we performed a subgroup analysis of different organ transplants. Our results revealed that vaccination appeared to induce a relatively poor HIR in LUT recipients (1st dose: 4.4%, 2nd dose: 28.4%) but a relatively strong one in LIT recipients (1st dose: 29.5%, 2nd dose: 64.5%). We found that the high proportion of older patients comprising the LUT group may be responsible for the low immune response. Narasimhan et al. [79] and Hallett et al. [55] included 63% and 58% of LUT patients aged >60 ane, respektivman. Sepandan,<50% of older recipients were included in LIT. In addition, the proportion of recipients receiving antimetabolite therapy was different [57,92]. Antimetabolites were used in a high proportion of LUT recipients, a high proportion of 99% reported by Narasimhan et al. [79], but less than 40% in LIT patients. Furthermore, patients who have a short time post-transplant have a strong immunosuppressive state [51,55,94]. Therefore, 34.9% of LUT recipients had a time post-transplant of fewer than 3 years [55], but only 28.4% of HT recipients [94]. Our subgroup analysis results also indicated that with the longer time post-transplant, the immunogenicity was strong in SOT recipients after vaccination. We speculate that this may be due to the longer time since immunosuppression induction.

cistanche benefis-ranfòse sistèm iminitè

Iminojenisite a parèt varye ak kalite vaksen an. Se poutèt sa, analiz sougwoup ki baze sou kalite vaksen yo te fèt. Nou te jwenn ke vaksen an mRNA ka lakòz yon HIR pi ​​fò pase vaksen yo inaktive (56.2% vs 24.8%), ki konsistan avèk etid anvan yo [104e106]. Saure et al. [106] te konpare to serokonvèsyon CoronaVac ak BNT162b2 lè yo te rekrite 56 261 moun. Yo te jwenn ke apre premye dòz CoronaVac nan semèn 4, 28.1% moun te gen antikò IgG pozitif pou SARS CoV-2. Pik la te 77.4% apre 2yèm dòz la nan semèn 3. Sepandan, serokonvèsyon an te 79.4% pandan semèn 4 apre li te resevwa 1ye dòz BNT162b2, ki te ogmante a 96.5% pandan semèn 3 apre 2yèm dòz la. Anplis de sa, konpare ak Sinovac, vaksen ak BNT162b2 te lakòz yon tit antikò ki pi wo nan popilasyon iminokonpwomi [104]. Mekanis ki kache a ta ka vaksen mRNA a te itilize selil lame pou fè sentèz antijèn pou SARS-CoV -2 ak deklanche yon repons iminitè fò [107,108]. Gen kèk limit nan etid sa a. Premyèman, pifò atik yo te syans obsèvasyon, ak anpil kontwòl sante nan syans enkli yo te travayè swen sante yo. Dezyèmman, pifò etid enkli te evalye vaksen HIR ak COVID-19. Sepandan, gen yon mank de done sou CIR la. Twazyèmman, anpil etid te itilize vaksen mRNA, men lòt kalite yo toujou manke. Anfen, diferan metòd tès pou HIR ak CIR yo te fèt nan diferan etid endividyèl yo. Valè koupe pou defini yon repons iminitè pozitif te diferan atravè etid, ki ka mennen nan potansyèl patipri. Konklizyon Yon vaksen rapèl amelyore iminojenisite vaksen COVID-19 nan SOT; sepandan, yon pati enpòtan nan benefisyè SOT yo toujou pa te konstwi yon repons iminitè umoral detektab apre 3yèm dòz la. Konklizyon sa a mande pou apwòch altènatif, tankou itilizasyon antikò monoklonal. Anplis de sa, pasyan transplantasyon nan poumon bezwen vaksinasyon rapèl ijan pou amelyore repons iminitè yo. Sepandan, yon mank de valè serolojik koupe ki gen rapò ak iminite pwoteksyon ak plizyè sit ki mitasyon SARS-CoV-2 ka deklanche chape iminitè kont repons iminitè umoral ak selilè ki egziste deja, ki mennen nan enfeksyon COVID-19.

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