The effect of splenectomy on the levels of PCV-13-induced memory B- and T cells

Gazi, Umut; Karasartova, Djursun; Şahiner, İbrahim Tayfun; Güreser, Ayşe Semra; Tosun, Özgür; Derici, Mehmet Kürşat; Dolapci, Mete; Taylan-Özkan, Ayşegül

doi:10.1111/ijcp.13077

Cited by 3 publications

(2 citation statements)

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“…Thereby, we could measure serotype-specific responses. Other prior studies on cellular immunity after pneumococcal vaccination used the conjugate, diphtheria toxin [18], or the complete vaccine containing the toxin [17,19,20] as antigenic stimulus. Thereby, the cellular assays were not specific for pneumococci but could also show responses to the conjugate.…”

Section: Discussionmentioning

confidence: 99%

Establishment of an ELISpot Assay to Detect Cellular Immunity against S. pneumoniae in Vaccinated Kidney Transplant Recipients

et al. 2021

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In organ transplant recipients, the rate of invasive pneumococcal diseases is 25 times greater than in the general population. Vaccination against S. pneumoniae is recommended in this cohort because it reduces the incidence of this severe form of pneumococcal infection. Previous studies indicate that transplant recipients can produce specific antibodies after pneumococcal vaccination. However, it remains unclear if vaccination also induces specific cellular immunity. In the current study on 38 kidney transplant recipients, we established an interferon-γ ELISpot assay that can detect serotype-specific cellular responses against S. pneumoniae. The results indicate that sequential vaccination with the conjugated vaccine Prevenar 13 and the polysaccharide vaccine Pneumovax 23 led to an increase of serotype-specific cellular immunity. We observed the strongest responses against the serotypes 9N and 14, which are both components of Pneumovax 23. Cellular responses against S. pneumoniae correlated positively with specific IgG antibodies (r = 0.32, p = 0.12). In conclusion, this is the first report indicating that kidney transplant recipients can mount specific cellular responses after pneumococcal vaccination. The ELISpot we established will allow for further investigations. These could help to define, for example, factors influencing specific cellular immunity in immunocompromised cohorts or the duration of cellular immunity after vaccination.

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Section: Discussionmentioning

confidence: 99%

Establishment of an ELISpot Assay to Detect Cellular Immunity against S. pneumoniae in Vaccinated Kidney Transplant Recipients

et al. 2021

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“…Studies targeting patients with splenectomy (Table 3) are biased by very low numbers of patients involved, different vaccine protocols, and various immunological assays used . Collectively, these confirm that PPSV23 can provide an efficient antibody response after an initial dose of PCV but not when PPSV23 is given initially.…”

Section: Whatmentioning

confidence: 99%

Perioperative Immunization for Splenectomy and the Surgeon’s Responsibility

2020

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plenectomy is a common operation, accounting for at least 25 000 procedures per year in the US. Indications include hematological diseases, traumatic injuries, and benign and malignant gastrointestinal, urological, and gynecologic conditions. The most dreadful sequel of splenectomy is overwhelming postsplenectomy infection (OPSI), a syndrome consisting of a nonspecific prodrome rapidly evolving toward pneumonia, meningitis, or fulminating sepsis. Although several strategies have been embraced, namely antibiotic prophylaxis, rescue therapy, and even splenic autotransplant, the cornerstone of OPSI prevention remains prophylactic immunization. Beyond the operating theater, surgeons play a determinant role in the care of patients who have had splenectomy. As the responsible physician in the immediate perioperative period, it is incumbent on them to first educate the patient regarding the nature of asplenic immunodeficiency and then prescribe appropriate immunization. Methods MEDLINE/PubMed, Cochrane Library, and ClinicalTrials.gov databases were searched for randomized clinical trials (RCTs) published from January 1, 1990, to December 31, 2019, addressing immunization in patients who had had splenectomy (eMethods in the Supplement). References of retrieved articles were searched manually, and current clinical guidelines were checked for further relevant literature. Research was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline methodology. 1 The research revealed 5 RCTs and 1 phase III nonrandomized trial (eFigure in the Supplement), Given the dearth of level I evidence focusing on the population of interest, results of systematic reviews, meta-analyses, and observational studies were also considered. Fi-IMPORTANCE Patients who have had splenectomy have a lifelong risk of overwhelming postsplenectomy infection (OPSI), a condition associated with high mortality rates. Surgeons must be aware of the rationale of vaccination in the case of splenectomy, to provide appropriate immunization in the perioperative time.OBSERVATIONS English-language articles published from January 1, 1990, to December 31, 2019, were retrieved from MEDLINE/PubMed, Cochrane Library, and ClinicalTrials.gov databases. Randomized clinical trials as well as systematic reviews and observational studies were considered. Asplenia yields an impairment of both innate and adaptive immunity, thus increasing the risk of severe encapsulated bacterial infections. Current epidemiology of OPSI ranges from 0.1% to 8.5% but is hard to ascertain because of ongoing shifts in patients' baseline conditions and vaccine penetration. Despite the lack of randomized clinical trials, immunization appears to be effective in reducing OPSI incidence. Unfortunately, vaccination coverage is still suboptimal, with a great variability in vaccination rates being reported across institutions and time frames. Notably, current guidelines do not advocate any particular health care qualification responsible for vac...

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