Mehmet KANBAY, Asiye KANBAY, Merve AKYOL, Enes ÇEVİK, Duygu UCKU, Cem TANRIÖVER, Barış AFŞAR, Adrian COVIC, Alberto ORTIZ, Carlo BASILE

Diyaliz ve böbrek nakli hastalarında SARS-CoV-2 mRNA aşısı sonrası immunojenesite: Sistematik derleme

Böbrek nakilli ve diyaliz hastaları COVID-19 enfeksiyonu açısından yüksek riskli gruptadırlar. Güncel klavuzlar bu nedenle bu hastaların öncelikli aşılanması gereken grupta olduğunu belirtmişlerdir. Bununla birlikte aşı sonrası antikor yanıt, koruyuculuğu, hücresel immün yanıt üzerine etkileri net olarak bilinmemektedir. Bu sistematik derlemede mRNA-tipi SARS-CoV-2 aşılamanın böbrek nakli ve diyaliz hastalarında antikor yanıtını ve antikor yanıtını etkileyen faktörlerin araştırılması yapıldı. Bu sistematik derlemeye 18 adet hemodiyaliz, periton diyaliz ve böbrek nakli hastalarında 2 doz COVID-19 mRNA aşısı uygulanan hastaların alındığı klinik çalışma dahil edildi. Çalışmalarda 2 doz COVID-19 mRNA aşısı sonrası böbrek nakli hastalarında %27,2, diyaliz hastalarında %88,5 antikor yanıtı saptanırken sağlıklı insanlarda %100 antikor yanıtı saptandı. İleri yaş, diyaliz süresi, immünsüpresif tedavi, düşük serum albumin, düşük serum lökosit, düşük serum lenfosit, düşük hemoglobin düzeyleri düşük antikor yanıtı ile ilişkili olduğu saptandı. COVID19 mRNA aşısı sonrası diyaliz ve böbrek nakli hastalarında antikor yanıtı düşüktür. Bu nedenle bu hasta grubunda üçüncü doz aşı uygulanması uygun olabilir

Immunogenicity of SARS-CoV-2 mRNA vaccine in dialysis and kidney transplant patients: A systematic review

Kidney transplant recipients and dialysis patients constitute a risk group for severe COVID-19. They are highly advised to get vaccinated according to the current guidelines. However, data on antibody response, cell responses and protection from events, and factors that might alter this response after a routine full series of vaccination remain incomplete for these populations. The aim of this article was to analyze the antibody responses after a full series ofmRNA-based SARS-CoV-2 vaccination in kidney transplantation and dialysis patients and to define the factors that alter seroconversion status in these populations. In this systematic review, 18 studies investigating the antibody response to full vaccination with two doses of COVID-19 mRNA vaccines in hemodialysis, peritoneal dialysis, and kidney transplant patients were included. Kidney transplant and dialysis patients have a lower seroconversion rate after mRNA-based SARS-CoV-2 vaccination than the healthy population: 27.2% for kidney transplantation, 88.5% for dialysis patients while all healthy control in these studies seroconverted. Moreover, anti-S antibody titers were lower in seroconverted kidney transplantation or dialysis patients than in healthy control in all studies that assessed this variable. Older age and dialysis vintage, immunosuppressive or chemotherapy treatment, and lower serum albumin, white blood cell, lymphocyte and hemoglobin counts were associated with lower/no antibody response to vaccination. Dialysis patients and kidney transplant recipients have lower seroconversion rates after a full series of mRNA-based SARS-CoV-2 vaccination than the general population. Several factors are associated with an altered antibody response. A third dose could be considered in this patient group.

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