Background

In the general population, mRNA SARS-CoV-2 vaccines are highly efficacious. Early reports suggest a diminished antibody response in immunosuppressed adult solid organ transplant (SOT) patients, but this has not been reported in pediatrics.

Methods

Adolescent kidney transplant recipients (KTR) at our center who received both doses of an mRNA SARS-CoV-2 vaccine had SARS-CoV-2 spike (S) protein antibody presence evaluated 4–8 weeks after their second dose of the vaccine as part of routine clinical care.

Results

Thirteen of 25 fully vaccinated patients (52%) had a positive spike antibody. Median age of participants was 19 years old (IQR 18–20) and the median time from transplant was 5 years (IQR 4–9 years). KTR were treated with an immunosuppression regimen including a calcineurin inhibitor, corticosteroid, and antimetabolite (9 with mycophenolate, 3 with azathioprine, and 1 without an antimetabolite due to viremia). Of those who had an antibody response, fewer had a mycophenolate-containing immunosuppressant regimen than non-responders. There was a trend toward better vaccine response and higher anti-S antibody titers at lower doses of mycophenolate. Three patients with prior COVID-19 infection all had a positive antibody response.

Conclusion

Our results suggest vaccine response in adolescent KRT is lower than that of the general population, but similar to that previously described in adult SOT patients and slightly better than that seen in adult KTR. This data demonstrates vaccination is safe and supports immunizing KTR who remain hesitant. Future studies should focus on better understanding of the cellular immune response to vaccination and strategies to enhance vaccine immunogenicity in pediatric SOT patients.

Graphical abstract

中文翻译：

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青少年肾移植受者 mRNA SARS-CoV-2 疫苗的免疫反应

背景

在普通人群中，mRNA SARS-CoV-2 疫苗非常有效。早期报告表明免疫抑制成人实体器官移植 (SOT) 患者的抗体反应减弱，但这在儿科尚未见报道。

方法

我们中心接受两剂 mRNA SARS-CoV-2 疫苗的青少年肾移植受者 (KTR) 在第二剂疫苗作为一部分后 4-8 周评估了 SARS-CoV-2 刺突 (S) 蛋白抗体的存在的常规临床护理。

结果

25 名完全接种疫苗的患者中有 13 名 (52%) 的尖峰抗体呈阳性。参与者的中位年龄为 19 岁（IQR 18-20），移植的中位时间为 5 年（IQR 4-9 年）。KTR 接受免疫抑制方案治疗，包括钙调神经磷酸酶抑制剂、皮质类固醇和抗代谢药（9 例用霉酚酸酯，3 例用硫唑嘌呤，1 例由于病毒血症而没有抗代谢药）。在有抗体反应的人中，接受含霉酚酸酯免疫抑制剂治疗的人比无反应者少。在较低剂量的霉酚酸酯下存在更好的疫苗反应和更高的抗 S 抗体滴度的趋势。三名先前感染过 COVID-19 的患者都有阳性抗体反应。

结论

我们的研究结果表明，青少年 KRT 的疫苗反应低于一般人群，但与之前在成人 SOT 患者中描述的相似，并且略好于成人 KTR。该数据表明疫苗接种是安全的，并支持对犹豫不决的 KTR 进行免疫接种。未来的研究应侧重于更好地了解对疫苗接种的细胞免疫反应以及增强儿科 SOT 患者疫苗免疫原性的策略。

图形概要