nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное общество10.28996/2618-9801-2022-4-884-891nid-94Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESОсобенности вакцинопрофилактики COVID-19 у реципиентов почечного трансплантатаFeatures of COVID-19 vaccine prophylaxis in renal graft recipientsКимИ. Г.KimI. G.kig21@rambler.ruНовиковаЛ. И.NovikovaL. I.noemail@neicon.ruФроловаН. Ф.FrolovaN. F.noemail@neicon.ruВолодинаЕ. В.VolodinaE. V.noemail@neicon.ruБочкареваС. С.BochkarevaC. C.noemail@neicon.ruВиноградовВ. Е.VinogradovV. E.noemail@neicon.ruОстровскаяИ. В.OstrovskayaI. V.noemail@neicon.ruИвановаЕ. С.IvanovaE. S.noemail@neicon.ruБердинскийВ. А.BerdinskyV. A.noemail@neicon.ruМальцеваМ. Е.MaltsevaM. E.noemail@neicon.ruСкрябинаИ. А.SkryabinaI. A.noemail@neicon.ruСтолбоваА. А.StolbovaA. A.noemail@neicon.ruФБУН «Московский НИИ эпидемиологии и микробиологии им. Г.Н. Габричевского Роспотребнадзора»; ГБУЗ «Городская клиническая больница № 52 Департамента здравоохранения Москвы»РоссияG.N. Gabrichevsky Moscow Research Institute of Epidemiology and Microbiology; Moscow City Hospital № 52Russian FederationФБУН «Московский НИИ эпидемиологии и микробиологии им. Г.Н. Габричевского Роспотребнадзора»РоссияG.N. Gabrichevsky Moscow Research Institute of Epidemiology and MicrobiologyRussian FederationГБУЗ «Городская клиническая больница № 52 Департамента здравоохранения Москвы»; ФГБОУ ВО «Московский государственный медико-стоматологический университет имени А.И. Евдокимова Минздрава России»РоссияMoscow City Hospital № 52; A.I. Evdokimov Moscow State University of Medicine and DentistryRussian FederationГБУЗ «Городская клиническая больница № 52 Департамента здравоохранения Москвы»РоссияMoscow City Hospital № 52Russian Federation202221062024244884891Copyright © Ким И.Г., Новикова Л.И., Фролова Н.Ф., Володина Е.В., Бочкарева С.С., Виноградов В.Е., Островская И.В., Иванова Е.С., Бердинский В.А., Мальцева М.Е., Скрябина И.А., Столбова А.А., 20242024Ким И.Г., Новикова Л.И., Фролова Н.Ф., Володина Е.В., Бочкарева С.С., Виноградов В.Е., Островская И.В., Иванова Е.С., Бердинский В.А., Мальцева М.Е., Скрябина И.А., Столбова А.А.Kim I.G., Novikova L.I., Frolova N.F., Volodina E.V., Bochkareva C.C., Vinogradov V.E., Ostrovskaya I.V., Ivanova E.S., Berdinsky V.A., Maltseva M.E., Skryabina I.A., Stolbova A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/94

С учетом высокой заболеваемости и тяжести течения COVID-19 у реципиентов почечного трансплантата (РПТ) вакцинация этой категории пациентов особенно актуальна и рассматривается в качестве одного из наиболее действенных методов профилактики SARS-CоV-2-инфекции. Цель исследования: оценить результаты вакцинопрофилактики COVID-19 и ее безопасность при применении отечественных вакцин у РПТ. Материалы и методы: в исследование включены 144 РПТ в возрасте 51,9±11,3 лет (муж. 66,2%). У 95,8% РПТ для иммунизации применяли вакцину Гам-КОВИД-Вак. Были выделены 2 группы в зависимости от объема обследования: в группе 1 (n=67) антитела класса IgG к S-белку SARS-CоV-2 (IgGs) определяли до и после стандартной вакцинации; в группе 2 (n=77) - только после ее завершения. Результативность вакцинации оценивали на основании сероконверсии у исходно серонегативных РПТ, по степени нарастания уровня АТ IgGs (>25%) после иммунизации у пациентов с COVID-19 в анамнезе и по отдаленной заболеваемости. Результаты: у исходно серонегативных пациентов в группе 1 не удалось достигнуть сероконверсии в 76,9% случаев, в группе 2 - у 59,3% РПТ. В обеих группах среди серопозитивных после вакцинопрофилактики пациентов медиана уровня протективных антител оказалась достоверно ниже у РПТ, исходно не имевших IgGs, по сравнению с пациентами с COVID-19 в анамнезе: 47,5 (24,8; 133,3) BAU/мл против 501,0 (395,4; 501,0) BAU/мл (p <0,001), соответственно в группе 1 и 63,0 (41,0; 108,0) BAU/ml против 501,0 (455,5; 501,0) BAU/ml (p <0,001), соответственно в группе 2. Уровень IgGs у РПТ группы 1 с COVID-19 в анамнезе возрастал с 110,5 (25,3; 244,0) BAU/мл до 501,0 (395,4; 501,0) BAU/мл (p <0,001), соответственно, до и после вакцинации. В отдаленные сроки после иммунизации 7 РПТ были инфицированы Sars-CoV-2, 6 из них были серонегативными, 1 пациент имел низкий уровень IgGs (32 BAU/ml). 1 больной умер вследствие ОРДС. Иммунизация не влияла на функцию почечного трансплантата. Выводы: полученные результаты свидетельствуют о низкой частоте гуморального ответа при использовании стандартных протоколов вакцинации РПТ от COVID-19, что определяет необходимость модификации схем иммунизации для повышения её эффективности.

The aim of the study was to evaluate the efficacy and safety of COVID-19 vaccine prophylaxis with vaccines produced in Russia in kidney transplant recipients. Materials and methods: the study included 144 renal transplant recipients (RTR) 51.9±11.3 years old (male 66.2%). In most cases (95.8%), the Gam-COVID-Vac vaccine was used for immunization. Patients were divided into 2 groups depending on the scope of the examination: in group 1 (n=67) IgG antibodies to the receptor-binding domain of SARS-COV-2 S-protein (IgGs) were determined before and after vaccination; in group 2 (n=77) only after vaccination. The duration of follow-up after the start of immunization was 66.8±28.3 days. The effectiveness of vaccination was assessed by seroconversion in initially seronegative RTR; in patients with COVID-19 in the anamnesis - by the degree of increase in the level of antibody IgGs (>25%) after immunization. Results: 14 out of 144 (9.7%) RTR (7 patients in each group) underwent COVID-19 within 35 days after the administration of the first dose of the vaccine and were excluded from the analysis. Initially seronegative patients in group 1 failed to achieve seroconversion in 76.9% of cases, and in group 2 in 59.3% of RTR. Among seropositive patients after vaccination in both groups, the level of IgGs was significantly lower in RTR, who initially did not have IgGs, compared with patients with COVID-19 in the anamnesis: 47.5 (24.8; 133.3) BAU/ml versus 501.0 (395.4; 501.0) BAU/ml, respectively, p <0.001 in group 1 and 63.0 (41.0; 108.0) BAU/ml versus 501.0 (455.5;501.0) BAU/ml, respectively, p <0.001 in group 2. The level of IgGs antibodies in RTR group 1, who had previously COVID-19 increased from 110.5 (25.3; 244.0) BAU/ml to 501.0 (395.4; 501.0) BAU/ml (p <0.001), respectively, before and after vaccination. In general, in the long term after immunization, 7 RTR were infected with SARS-CoV-2, 6 of them were seronegative, and 1 patient with seroconversion had a low level of IgGs antibodies (32 BAU/ml); 1 patient died due to ARDS. Immunization did not affect the function of the kidney graft. Conclusions: obtained results indicate a low frequency of humoral response when using standard vaccination protocols against COVID-19 in RPT, which necessitates modification of their immunization regimens with an analysis of not only the effectiveness and safety but also the duration of protection of its enhanced variants.

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The authors declare that there are no conflicts of interest present.