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      Cellular immune response of SARS-CoV-2 vaccination in kidney transplant recipients: a systematic review and meta-analysis

      systematic-review

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          Abstract

          Background

          Evidence has demonstrated inferior humoral immune responses after SARS-CoV-2 vaccination in kidney transplant recipients compared to the general population. However, data on cellular immune responses in this population have not been established.

          Methods

          We searched the MEDLINE, Scopus, and Cochrane databases and included studies reporting cellular immune response rates in kidney transplant recipients after receiving SARS-CoV-2 vaccines. Studies that reported factors associated with cellular immune responders or non-responders were also included (PROSPERO: CRD42022375544).

          Results

          From a total of 1,494 articles searched, 53 articles were included in the meta-analysis. In all, 21 studies assessed cellular immune response by interferon-γ enzyme-linked immunosorbent spot (IFN-γ ELISPOT), 22 studies used interferon-γ release assay (IGRA), and 10 studies used flow cytometric analysis. The pooled response rate after two doses (standard regimen) and three doses of vaccination was 47.5% (95%CI 38.4-56.7%) and 69.1% (95%CI 56.3-80.6%) from IFN-γ ELISPOT, 25.8% (95%CI 19.7-32.4%) and 14.7% (95%CI 8.5-22.2%) from IGRA, and 73.7% (95%CI 55.2-88.8%) and 86.5% (95%CI 75.3-94.9%) from flow cytometry, respectively. Recipients with seroconversion were associated with a higher chance of having cellular immune response (OR 2.58; 95%CI 1.89-3.54). Cellular immune response in kidney transplant recipients was lower than in dialysis patients (OR 0.24; 95%CI 0.16-0.34) and the general population (OR 0.10; 95%CI 0.07-0.14). Age and immunosuppressants containing tacrolimus or corticosteroid were associated with inferior cellular immune response.

          Conclusion

          Cellular immune response after SARS-CoV-2 vaccination in kidney transplant recipients was lower than in dialysis patients and the general population. Age, tacrolimus, and corticosteroid were associated with poor response. Cellular immune response should also be prioritized in vaccination studies.

          Systematic review registration

          https://www.crd.york.ac.uk/prospero/, identifier CRD42022375544.

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          Most cited references78

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          The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

          The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.
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            Bias in meta-analysis detected by a simple, graphical test

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              Robust T cell immunity in convalescent individuals with asymptomatic or mild COVID-19

              Summary SARS-CoV-2-specific memory T cells will likely prove critical for long-term immune protection against COVID-19. We here systematically mapped the functional and phenotypic landscape of SARS-CoV-2-specific T cell responses in unexposed individuals, exposed family members, and individuals with acute or convalescent COVID-19. Acute phase SARS-CoV-2-specific T cells displayed a highly activated cytotoxic phenotype that correlated with various clinical markers of disease severity, whereas convalescent phase SARS-CoV-2-specific T cells were polyfunctional and displayed a stem-like memory phenotype. Importantly, SARS-CoV-2-specific T cells were detectable in antibody-seronegative exposed family members and convalescent individuals with a history of asymptomatic and mild COVID-19. Our collective dataset shows that SARS-CoV-2 elicits robust, broad and highly functional memory T cell responses, suggesting that natural exposure or infection may prevent recurrent episodes of severe COVID-19.
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                Author and article information

                Contributors
                URI : https://loop.frontiersin.org/people/1411281
                URI : https://loop.frontiersin.org/people/881233
                URI : https://loop.frontiersin.org/people/1923309
                Journal
                Front Immunol
                Front Immunol
                Front. Immunol.
                Frontiers in Immunology
                Frontiers Media S.A.
                1664-3224
                26 July 2023
                2023
                26 July 2023
                : 14
                : 1220148
                Affiliations
                [1] 1 Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital , Bangkok, Thailand
                [2] 2 Excellence Center for Organ Transplantation (ECOT), King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
                [3] 3 Renal Immunology and Transplantation Research Unit, Faculty of Medicine, Chulalongkorn University , Bangkok, Thailand
                [4] 4 HIV-NAT, Thai Red Cross AIDS Research Centre , Bangkok, Thailand
                [5] 5 Center of Excellence on Translational Research in Inflammation and Immunology (CETRII), Department of Microbiology, Chulalongkorn University , Bangkok, Thailand
                [6] 6 Immunology Unit, Department of Microbiology, Chulalongkorn University , Bangkok, Thailand
                [7] 7 Biostatistics Excellence Centre, Research Affairs, Faculty of Medicine, Chulalongkorn University , Bangkok, Thailand
                [8] 8 The Kirby Institute, University of New South Wales , Sydney, NSW, Australia
                Author notes

                Edited by: Alain Le Moine, Université libre de Bruxelles, Belgium

                Reviewed by: Naoki Tanimine, National Hospital Organization Kure Medical Center, Japan; Caroline La, Université libre de Bruxelles, Belgium; Nicolas Gemander, Université libre de Bruxelles, Belgium, in collaboration with reviewer CL

                *Correspondence: Suwasin Udomkarnjananun, suwasin.u@ 123456gmail.com
                Article
                10.3389/fimmu.2023.1220148
                10415203
                e5a90140-7c0c-47be-bfbf-1ceb9fe8ad67
                Copyright © 2023 Udomkarnjananun, Gatechompol, Leelahavanichkul and Kerr

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 10 May 2023
                : 05 July 2023
                Page count
                Figures: 5, Tables: 2, Equations: 0, References: 78, Pages: 15, Words: 6147
                Funding
                Funded by: Chulalongkorn University , doi 10.13039/501100002873;
                Award ID: CU_GR_63_157_30_60
                This study is supported by the Ratchadapisek Sompoch Endowment Fund of Chulalongkorn University (CU_GR_63_157_30_60).
                Categories
                Immunology
                Systematic Review
                Custom metadata
                Alloimmunity and Transplantation

                Immunology
                cellular immune response,covid-19,elispot,flow cytometry,interferon-γ,kidney transplantation,sars-cov-2 vaccine,t cells

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