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1.
Clin Transplant ; 36(12): e14825, 2022 12.
Article in English | MEDLINE | ID: mdl-36301197

ABSTRACT

INTRODUCTION: Kidney transplant patients (KT) are at high risk for severe COVID-19 and presented attenuated antibody responses to vaccination when compared to immunocompetent individuals. Torquetenovirus (TTV) has recently gained attention as a potential surrogate marker of the net state of immunosuppression. We evaluated the association between pre-vaccination TTV viral load and anti-spike total antibody response to SARS-CoV-2 vaccination in KT. MATERIAL AND METHODS: The 114 adult KT recipients enrolled in this prospective single-center cohort study received two doses of SARS-CoV-2 mRNA BNT162b2 vaccine. Serum samples were collected immediately before vaccination at the days when patients received both the first (T0) and the second dose (T1) and 16-45 days after the second dose (T2). Primary endpoint was the development of anti-spike total antibodies after vaccination. Demographic, clinical, and laboratorial parameters were compared between patients with and without detectable SARS-CoV-2 antibodies at T2. RESULTS: Ninety-nine patients (86.8%) were naïve for SARS-CoV-2 before vaccination. Fifty-six (56.6%) patients developed anti-spike total antibodies at T2. The use of mTOR inhibitors was associated with a favorable response (p = .005); conversely, mycophenolic acid (MPA) was associated with a negative response (p = .006). In a multivariable model, the presence of TTV at T0 ≥ 3.36 log10 cp/ml was associated with unfavorable vaccine response (OR: 5.40; 95% CI: 1.47-19.80; p = .011), after adjusting for age and eGFR at T0. CONCLUSIONS: Higher TTV viral loads before vaccination are associated with reduced anti-spike total antibody response in SARS-CoV-2 mRNA BNT162b2 vaccinated KT patients. The association between TTV viral load and vaccine response may be an added-value in the optimization of vaccination regimens in KT.


Subject(s)
COVID-19 , Kidney Transplantation , Adult , Humans , BNT162 Vaccine , COVID-19 Vaccines , Antibody Formation , SARS-CoV-2 , Cohort Studies , Prospective Studies , Viral Load , Vaccination , Antibodies, Viral
2.
Nat Commun ; 13(1): 140, 2022 01 10.
Article in English | MEDLINE | ID: mdl-35013258

ABSTRACT

While mRNA vaccines are administrated worldwide in an effort to contain the COVID-19 pandemic, the heterogeneity of the humoral immune response they induce at the population scale remains unclear. Here, in a prospective, longitudinal, cohort-study, including 1245 hospital care workers and 146 nursing home residents scheduled for BNT162b2 vaccination, together covering adult ages from 19 to 99 years, we analyse seroconversion to SARS-CoV-2 spike protein and amount of spike-specific IgG, IgM and IgA before vaccination, and 3-5 weeks after each dose. We show that immunogenicity after a single vaccine dose is biased to IgG, heterogeneous and reduced with increasing age. The second vaccine dose normalizes IgG seroconversion in all age strata. These findings indicate two dose mRNA vaccines is required to reach population scale humoral immunity. The results advocate for the interval between the two doses not to be extended, and for serological monitoring of elderly and immunosuppressed vaccinees.


Subject(s)
Antibodies, Viral/immunology , BNT162 Vaccine/immunology , COVID-19/immunology , Immunization, Secondary , SARS-CoV-2/immunology , Adult , Age Factors , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/prevention & control , Female , Humans , Immunogenicity, Vaccine , Longitudinal Studies , Male , Middle Aged , Portugal/epidemiology , Prospective Studies , Seroconversion , Vaccination , Young Adult
3.
Transpl Infect Dis ; 23(2): e13524, 2021 Apr.
Article in English | MEDLINE | ID: mdl-33226684

ABSTRACT

Kidney transplant (KT) recipients are at an increased risk for severe COVID-19 because of their immunosuppressed state. A 42-year-old KT patient was diagnosed with COVID-19 three months after KT. Despite lymphopenia and several risk factors, he had a mild disease course. Nasopharyngeal real-time reverse transcriptase polymerase chain reaction for SARS-CoV-2 became negative 48 days after detection. SARS-CoV-2 IgG antibodies became negative after day 40. TTV DNA load increased with the onset COVID-19 and reduced after its resolution. This is the first report where TTV DNA load was measured during the course of COVID-19.


Subject(s)
Antibodies, Viral/immunology , COVID-19/immunology , DNA Virus Infections/immunology , DNA, Viral/metabolism , Immunocompromised Host , Immunoglobulin G/immunology , Kidney Transplantation , Torque teno virus/genetics , Adult , COVID-19/epidemiology , COVID-19 Nucleic Acid Testing , COVID-19 Serological Testing , Comorbidity , Diabetes Mellitus/epidemiology , Glucocorticoids/therapeutic use , Graft Rejection/prevention & control , Humans , Hypertension/epidemiology , Immunoglobulin M/immunology , Immunosuppressive Agents/adverse effects , Kinetics , Lymphopenia/immunology , Male , Mycophenolic Acid/adverse effects , Obesity/epidemiology , Prednisolone/therapeutic use , SARS-CoV-2/immunology , Severity of Illness Index , Tacrolimus/adverse effects , Viral Load
4.
J Matern Fetal Neonatal Med ; 22(10): 934-5, 2009 Oct.
Article in English | MEDLINE | ID: mdl-19488938

ABSTRACT

Acute aortic dissection is a rare life-threatening event. No further pregnancies in women who had a previous acute aortic dissection have been reported. We present the case of a chronic hypertensive woman, who in her previous gestation was submitted to an acute aortic dissection repair at 28 weeks of gestation with cesarean delivery at the same operative procedure. The index pregnancy was uneventful. An elective cesarean was performed at 33 weeks' gestation. Aneurysm expansion, rupture or redissections are potential complications of operated aortic dissection. Normal blood pressure values and close cardiologic and obstetrical follow-up are essential to obtain a favourable outcome.


Subject(s)
Aortic Aneurysm/rehabilitation , Aortic Dissection/rehabilitation , Gravidity , Pregnancy Complications, Cardiovascular/rehabilitation , Acute Disease , Adult , Aortic Dissection/surgery , Aortic Aneurysm/surgery , Cesarean Section/rehabilitation , Female , Humans , Pregnancy , Pregnancy Complications, Cardiovascular/surgery , Pregnancy Outcome
5.
J Matern Fetal Neonatal Med ; 21(3): 209-11, 2008 Mar.
Article in English | MEDLINE | ID: mdl-18297576

ABSTRACT

Aneurysms of the vein of Galen (AVG) represent less than 1% of all intracranial arteriovenous malformations. Two cases of prenatal diagnosis made by color Doppler ultrasonography at 32 weeks of gestation are reported. Both cases presented with antenatal mild cardiomegaly and both developed severe cardiac failure in the neonatal period. Embolization was unsuccessful and both infants died. These cases highlight the need for a careful evaluation of the time and mode of delivery; embolization must be performed after a fully informed decision.


Subject(s)
Ultrasonography, Prenatal , Vein of Galen Malformations/diagnostic imaging , Adult , Cardiomegaly/etiology , Embolization, Therapeutic/adverse effects , Fatal Outcome , Female , Heart Failure/etiology , Humans , Infant, Newborn , Intracranial Aneurysm/congenital , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/surgery , Male , Pregnancy , Pregnancy Trimester, Third , Vein of Galen Malformations/complications , Vein of Galen Malformations/surgery
6.
J Perinat Med ; 35(1): 62-6, 2007.
Article in English | MEDLINE | ID: mdl-17313312

ABSTRACT

OBJECTIVE: The aim of our study is to evaluate the clinical importance of near term weight discordance in twin pregnancies with both appropriate or with one small for gestational age newborn (AGA and SGA, respectively). METHODS: We retrospectively studied 230 twin pregnancies that ended at >or=34 weeks' gestation. Discordance was defined as an intertwin birth weight difference>or=20% calculated from the heavier newborn. The following data were compared between discordant and concordant pairs: maternal age, parity, mode of conception, placentation, hypertensive disorders of pregnancy, gestational age at birth, route of delivery, reason for termination of pregnancy, Apgar scores, birth weights, admission to neonatal intensive care unit, significant morbidity, malformations found at birth, and perinatal mortality. The discordant pairs were subdivided into two groups: (1) Both twins were AGA; (2) One of the twins was SGA. The two groups were compared to each other, and to the control group of concordant pairs. RESULTS: One hundred and seventy-six twin pairs were concordant (control group) and 54 were discordant. The comparison between the concordant and the discordant groups did not show statistically significant differences in any of the examined parameters. However, the discordant group had a greater incidence of neonatal morbidity. When the discordant subgroups (AGA, n=24 vs. SGA n=30) were compared to the concordant group, these differences persist, particularly in the SGA group. CONCLUSION: In near term twin pregnancies, birth weight discordance does not seem to predict adverse perinatal outcome except when one of the newborns is SGA.


Subject(s)
Birth Weight/physiology , Infant, Newborn/physiology , Infant, Small for Gestational Age/physiology , Twins/physiology , Adult , Female , Humans , Pregnancy , Pregnancy Outcome , Retrospective Studies
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