儿童肝移植后麻疹免疫力降低 - 一个回顾性,单中心,横截面分析分析
Tobias Laue1, Norman Junge1, Christoph Leiskau2
1Division for Paediatric Gastroenterology and Hepatology, Department of Paediatric Kidney, Liver, and Metabolic Diseases, Hannover Medical School, Hannover, Germany.
PloS one
|February 5, 2024
概括
儿科肝移植接受者在移植后显示麻疹免疫力降低. 在移植之前进行疫苗接种,即使是早期,对于在这些易受伤害的儿童中获得麻疹免疫力至关重要.
科学领域:
- 免疫学 免疫学 免疫学
- 儿科胃肠病学和肝病学
- 移植医学 移植医学
背景情况:
- 儿童的肝移植提供了优秀的长期结果,但具有很大的感染风险.
- 麻疹感染可以导致严重的并发症,包括移植排斥,机械呼吸和死亡,在儿科肝移植接受者.
- 移植后使用活疫苗是禁忌的,肝病患者的免疫反应往往较差.
研究的目的:
- 在移植前和移植后检查儿科肝移植接受者的麻疹免疫力.
- 在这个患者群体中识别与麻疹免疫相关的因素.
- 为改善儿童肝移植候选人和接受者麻疹保护的疫苗接种策略提供信息.
主要方法:
- 这是一项回顾性,单中心,横截面研究,分析了211名儿科肝移植接受者的疫苗接种记录.
- 纳入标准侧重于2021年1月至2022年12月期间在汉诺威医学院接受的患者.
- 统计分析包括多变量考克斯比例危险回归,以确定麻疹免疫力的独立预测因素.
主要成果:
- 超过55%的分析儿童是移植后的麻疹病毒阳性,与健康个体相比,在接种了一次 (48%) 和两次 (84%) 疫苗后的比率较低.
- 26%的未接种疫苗的儿童和5-15%的最初血清阴性接种疫苗的患者表现出抗体,表明可能感染.
- 与移植后免疫相关的独立因素包括接种疫苗的数量,移植前血清阳性和第一次接种疫苗时的年龄较大;在测试时的年龄较大表明免疫力下降.
结论:
- 在患有肝病的儿童中,疫苗对麻疹的反应较差,急性肝衰竭患者表现最低的标位.
- 建议在肝移植之前接种疫苗,即使是在生命的第一年,也不构成非免疫的风险.
- 监测麻疹IgG和移植后重新接种血清阴性患者的疫苗是确保足够免疫力的重要策略.
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