肝移植后减毒活疫苗失效：一项为期 20 年的队列研究。

IF 4.5 3区医学 Q2 IMMUNOLOGY

Vaccine Pub Date : 2024-11-14 DOI:10.1016/j.vaccine.2024.126527

Munehiro Furuichi , Takuma Ohnishi , Mizuki Yaginuma , Yohei Yamada , Ken Hoshino , Tetsuo Nakayama , Masayoshi Shinjoh

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引用次数: 0

摘要

背景：最近一项有条件的建议建议考虑为实体器官移植受者接种减毒活疫苗，但安全有效接种的条件仍不明确：这项前瞻性研究于 2002 年至 2023 年 8 月在庆应义塾大学医院进行。我们为符合减毒活疫苗标准（包括体液免疫和细胞介导免疫标准）的肝移植（LT）受者接种了减毒活疫苗。研究人员收集了患者的背景信息、免疫日期、疫苗株、接种时的免疫抑制剂以及抗体滴度。评估与初次和二次疫苗接种失败有关的因素，以提高LT后减毒活疫苗接种计划的有效性：结果：在 67 名接受长效免疫接种的患者中，分别有 54 人、55 人、47 人和 55 人接种了至少一剂麻疹、风疹、水痘和流行性腮腺炎减毒活疫苗。疫苗菌株的不同与疫苗接种失败的风险较低有关，但与使用两种或两种以上免疫抑制剂无关。使用 AIK-C 株的麻疹疫苗的初次和二次失败率明显低于 CAM-70 株（1/38 vs. 4/16，几率比：0.08，95% 置信区间 [CI]：0.01-0.80，p.0）：危险比：0.54，95% 置信区间 [CI]：0.34-0.85，P = 0.01）。TO-336株风疹未出现初治失败，而松浦株风疹的10名LT受试者中有4人未发生血清转换。就流行性腮腺炎而言，星野菌株的初次失败率低于鸟居菌株（15/52 对 3/3，P = 0.03）：结论：根据一项长达 20 年的长期研究，疫苗株是影响移植后减毒活疫苗接种初次和继发失败的最关键因素。

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Live-attenuated vaccine failure after liver transplantation: A 20-year cohort study

Background

A recent conditional recommendation suggests considering live-attenuated vaccines for solid organ transplant recipients, yet the conditions of their safe and effective administration remain unclear.

Methods

This prospective study was conducted at Keio University Hospital from 2002 to August 2023. We gave a live-attenuated vaccine to liver transplant (LT) recipients fulfilling criteria for live-attenuated vaccines, including criteria for humoral and cell-mediated immunity. Patient background information, immunization date, vaccine strain, immunosuppressive agents at the time of vaccination, and antibody titers were collected. Factors related to primary and secondary vaccine failure were evaluated to enhance the effectiveness of the live-attenuated vaccine program after LT.

Results

Among 67 LT recipients, 54, 55, 47, and 55 received at least one dose of live-attenuated vaccine for measles, rubella, varicella, and mumps, respectively. The difference in vaccine strains, but not the use of two or more immunosuppressive agents, was associated with a lower risk of vaccine failures. Measles vaccine with the AIK-C strain exhibited significantly lower primary and secondary failure rates than the CAM-70 strain (1/38 vs. 4/16, odds ratio: 0.08, 95 % confidence interval [CI]: 0.01–0.80, p = 0.02, and hazard ratio: 0.54, 95 % CI: 0.34–0.85, p = 0.01, respectively). No primary failures were observed with the TO-336 strain of rubella, whereas 4 of 10 LT recipients with the Matsuura strain of rubella did not seroconvert. For mumps, the Hoshino strain showed lower primary failure rates than the Torii strain (15/52 vs. 3/3, p = 0.03).

Conclusion

According to a 20-year long-term study, vaccine strains are the most critical factor influencing primary and secondary vaccine failure in post-transplant live-attenuated vaccination.

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来源期刊

Vaccine 医学-免疫学

CiteScore

8.70

自引率

5.50%

发文量

992

审稿时长

131 days

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