A third injection of the BNT162b2 mRNA COVID-19 vaccine in kidney transplant recipients improves the humoral immune response

Masset, Christophe; Kerleau, Clarisse; Garandeau, Claire F.; Ville, Simon; Cantarovich, Diego; Hourmant, Maryvonne; Kervella, Delphine; Houzet, Aurélie; Guillot-Gueguen, Cécile; Guihard, Irène; Giral, Magali; Dantal, Jacques; Blancho, Gilles

doi:10.1016/j.kint.2021.08.017

Cited by 60 publications

(93 citation statements)

References 6 publications

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“…Previous research has focused on the response of solid organ transplant recipients after a third vaccine dose. 1,2,9,10 While improvements have been observed for both B and T responses, a significant proportion of non-responders (30–50%) was reported. In a double-blind, randomized, placebo-controlled trial of a third dose of mRNA-1273 vaccine, Hall et al 3 found a higher neutralizing activity in the vaccine group versus the placebo group (median percent virus neutralization: 71% versus 25%, respectively).…”

Section: Discussionmentioning

confidence: 99%

A fourth dose of the mRNA-1273 SARS-CoV-2 vaccine improves serum neutralization against the delta variant in kidney transplant recipients

Benotmane

Bruel

Planas

et al. 2021

Preprint

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In immunocompetent subjects, the effectiveness of SARS-CoV-2 vaccines against the delta variant appears three- to five-fold lower than that observed against the alpha variant. Additionally, three doses of SARS-CoV-2 mRNA-based vaccines might be unable to elicit a sufficient immune response against any variant in immunocompromised kidney transplant recipients. This study describes the kinetics of the neutralizing antibody (NAbs) response against the delta strain before and after a fourth dose of a mRNA vaccine in 67 kidney transplant recipients who had experienced a weak antibody response after three doses. While only 16% of patients harbored NAbs against the delta strain prior to the fourth injection – this percentage raised to 66% afterwards. We also found that, after the fourth dose, the NAbs titer increased significantly (p=0.0001) from <7.5 (IQR : <7.5−15.1) to 47.1 (IQR <7.5−284.2). Collectively, our data indicate that a fourth dose of the mRNA-1273 vaccine in kidney transplant recipients with a weak antibody response after three previous doses improves serum neutralization against the delta variant.

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Section: Discussionmentioning

confidence: 99%

A fourth dose of the mRNA-1273 SARS-CoV-2 vaccine improves serum neutralization against the delta variant in kidney transplant recipients

Benotmane

Bruel

Planas

et al. 2021

Preprint

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“…In particular, the very low titers in KTR are alarming, not only regarding the potential of vaccines to protect against COVID-19 disease, but also the longevity of the supposed protection. Several trials have already reported on immune responses to a third vaccine dose in KTR non-responders [ 28 , 29 , 30 ] and weak responders [ 31 ], as well as HD patients [ 32 , 33 ]. Approximately 50% of KTR developed a positive AB response after a third dose.…”

Section: Discussionmentioning

confidence: 99%

Antibody Response to mRNA Vaccines against SARS-CoV-2 with Chronic Kidney Disease, Hemodialysis, and after Kidney Transplantation

Buchwinkler

Solagna

Messner

et al. 2021

JCM

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Most trials on mRNA vaccines against SARS-CoV-2 did not include patients with chronic kidney disease (CKD), hemodialysis (HD) patients, or kidney transplant recipients (KTR). However, those patients have a higher risk for a severe course of COVID-19 disease and mortality. Available literature has demonstrated a reduced efficacy of mRNA vaccines in HD patients and KTR, while data on CKD patients is scarce. Additionally, factors associated with non-response are poorly understood and not well characterized. We assessed antibody (AB) response (n = 582, 160 CKD patients, 206 patients on HD, 216 KTR) after the administration of two doses of a mRNA-vaccine with either BNT162b2 or mRNA-1273. AB measurements were carried out after a median of 91 days after first vaccinations, demonstrating non-response in 12.5% of CKD patients, 12.1% of HD patients, and 50% of KTR. AB titers were significantly higher in CKD patients than in HD patients or KTR. Factors associated with non-response were treated with rituximab in CKD patients, the use of calcineurin inhibitors in HD patients and older age, and the use of BNT162b2, mycophenolic acid, or glucocorticoids and lower hemoglobin levels in KTR. This study contributes to the understanding of the extent and conditions that predispose for non-response in patients with impaired kidney function.

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“…By end June 2021, the first global publication focusing on D3 was published, primarily involving transplanted patients (38). This was quickly followed by other series confirming the beneficial contribution of D3 in these immunocompromised patients (39)(40). In a randomized trial (41), either D3 or placebo was randomly administered to transplanted patients, using mRNA-1273 vaccine (Moderna) at Month 2 following D2 injection.…”

Section: Third Dose Data In Immunocompromised Patientsmentioning

confidence: 99%

Third dose of anti-SARS-CoV-2 vaccine for patients with cancer: Should humoral responses be monitored? A position article

Barrière

Carlès

Audigier-Valette

et al. 2022

European Journal of Cancer

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Taking into account higher risk of severe coronavirus disease 2019 (COVID-19) or death among patients with cancer, as well as impaired immunogenicity following anti-SARS-CoV-2 vaccines, in addition to waning immunity, booster dosing appears mandatory in this patient population. This review sought to provide reasonable evidence so as to assist oncologists in their daily practice, helping them decide when an anti-SARS-Cov2 antibodies (Abs) dosage should be scheduled following a full two-dose vaccination and if necessary, propose an early third dose (D3). Such D3 could apply to non-responder patients with anti-Spike (S) Abs titers < 40 binding antibody units (BAU)/mL. For low-responder patients with anti-S Abs titers between 40 BAU/mL and 100/260 BAU/mL (suggested area of uncertainty), an early D3 may similarly be proposed. Nevertheless, this D3 could be administered in a less urgent manner, taking into account associated co-morbidities and regional epidemic incidence rates. This latter strategy may comprise a monthly dosage of anti-S titers so as to better assess the kinetics of waning immunity. For responder patients with anti-S titers above 260 BAU/mL, we suggest to follow the recommendations outlined for the general population. Given this context, patients with anti-S titers above 1000 BAU/mL should be given the possibility to undergo anti-S titer control after 3 months, designed to assess rapid humoral waning immunity. We strongly recommend that patients with cancer be included into observational serological monitoring studies or clinical trials that are dedicated to severe immunocompromised patients without any humoral seroconversion after D3.

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A third injection of the BNT162b2 mRNA COVID-19 vaccine in kidney transplant recipients improves the humoral immune response

Cited by 60 publications

References 6 publications

A fourth dose of the mRNA-1273 SARS-CoV-2 vaccine improves serum neutralization against the delta variant in kidney transplant recipients

A fourth dose of the mRNA-1273 SARS-CoV-2 vaccine improves serum neutralization against the delta variant in kidney transplant recipients

Antibody Response to mRNA Vaccines against SARS-CoV-2 with Chronic Kidney Disease, Hemodialysis, and after Kidney Transplantation

Third dose of anti-SARS-CoV-2 vaccine for patients with cancer: Should humoral responses be monitored? A position article

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