这是首次系统回顾和荟萃分析,以确定在接受2剂严重急性呼吸综合征冠状病毒2(SARS-CoV-2)疫苗后导致器官移植受者抗体反应不良的因素。
数据来自Embase,PubMed,WebofScience,科克伦图书馆,中国国家知识基础设施(CNKI),和中国生物医学文献数据库(CBM)。根据纳入和排除标准,我们的研究包括了与实体器官移植受者对2剂量SARS-CoV-2疫苗的抗体反应相关的研究。两名研究者完成了文献检索,筛选,和数据提取。使用随机模型获得结果。进行Egger测试以确定发表偏倚。进行灵敏度分析以确定结果的稳定性。使用Galbraith图和亚组分析确定异质性。
本研究共纳入29项研究。这些因素包括活体捐赠者,BNT162b2,他克莫司,环孢菌素,抗代谢物,霉酚酸(MPA)或霉酚酸酯(MMF),硫唑嘌呤,皮质类固醇,大剂量皮质类固醇,belatacept,哺乳动物雷帕霉素靶蛋白(mTOR)抑制剂,三联疗法,年龄,估计肾小球滤过率(eGFR),血红蛋白,和他克莫司水平差异显著。多因素分析显示年龄差异显著,糖尿病,MPA或MMF,大剂量皮质类固醇,三联疗法,和eGFR。
接受2剂量SARS-CoV-2疫苗的器官移植患者抗体阴性反应的可能独立危险因素包括年龄,糖尿病,eGFR低,MPA或MMF,大剂量皮质类固醇,和三重免疫抑制疗法。mTOR抑制剂可以是对抗弱抗体应答的保护因子。
PROSPERO,标识符CRD42021257965。
This is the first systematic review and meta-analysis to determine the factors that contribute to poor antibody response in organ transplant recipients after receiving the 2-dose severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine.
Data was obtained from Embase, PubMed, Web of Science, Cochrane Library,
China National Knowledge Infrastructure (CNKI), and Chinese Biomedical Literature Database (CBM). Studies reporting factors associated with antibody responses to the 2-dose SARS-CoV-2 vaccine in solid organ transplant recipients were included in our study based on the inclusion and exclusion criteria. Two researchers completed the literature search, screening, and data extraction. Randomized models were used to obtain results. Egger\'s test was performed to determine publication bias. Sensitivity analysis was performed to determine the stability of the result. The heterogeneity was determined using the Galbraith plot and subgroup analysis.
A total of 29 studies were included in the present study. The factors included living donor, BNT162b2, tacrolimus, cyclosporine, antimetabolite, mycophenolic acid (MPA) or mycophenolate mofetil (MMF), azathioprine, corticosteroids, high-dose corticosteroids, belatacept, mammalian target of rapamycin (mTOR) inhibitor, tritherapy, age, estimated glomerular filtration rate (eGFR), hemoglobin, and tacrolimus level were significantly different. Multivariate analysis showed significant differences in age, diabetes mellitus, MPA or MMF, high-dose corticosteroids, tritherapy, and eGFR.
The possible independent risk factors for negative antibody response in patients with organ transplants who received the 2-dose SARS-CoV-2 vaccine include age, diabetes mellitus, low eGFR, MPA or MMF, high-dose corticosteroids, and triple immunosuppression therapy. mTOR inhibitor can be a protective factor against weak antibody response.
PROSPERO, identifier CRD42021257965.