Comparison of the immunogenicity of ChAdOx1 nCoV-19 vaccine against the wild-type and delta variants in kidney transplant recipients and healthy volunteers

Abstract

Little is known about immunogenicity after ChAdOx1 nCov‐19 vaccination after transplantation. We assessed the vaccine response by antibody testing, surrogate neutralization test (sVNT) against wild‐type (WT) and delta variant (DT), and T cell assay in 83 kidney transplant recipients (KTRs) and 52 healthy volunteers (HVs). For KTRs, a positive anti‐RBD antibody was seen in 2.8% after one dose and 15.7% after two doses of the vaccine. After two doses, the positivity rate by sVNT was equal (4.9% each, for WT and DT) and was 13.4% by T cell response. Post two doses, KTRs had significantly lower geometric mean titer than HVs (1.93 [95% CI: 1.39–2.69] vs. 248.3 [95% CI: 203.7–302.6] BAU/ml, respectively, p < .001). Daily mycophenolate dose of ≥1000 mg significantly associated with negative seroconversion [risk ratio (RR) of 0.33, 95% CI: 0.15–0.72, p = .005]. Compared with cyclosporine, daily tacrolimus dose of ≤3 mg and >3 mg of tacrolimus significantly associated with negative seroconversion [RR = 0.38 (95% CI, 0.17–0.85, p = .018) and RR = 0.16 (95% CI, 0.37–0.73, p = .018)], respectively. The vaccine was safe and well‐tolerated but the immune response after the two doses of ChAdOx1 nCov‐19 vaccine in KTRs was very low.

ChAdOx1 nCoV-19 Immunogenicity and Immunological Response Following COVID-19 Infection in Patients Receiving Maintenance Hemodialysis

“…Our results show that anti-spike IgG levels were considerably greater 1 mont each dosage of ChAdOx1 nCoV-19 in ESRD patients receiving hemodialysis, whic consistent with humoral responses following a single dose of ChAdOx1 nCoV-19 [ and two doses of ChAdOx1 nCoV-19 [31,32]. ChAdOx1 nCoV-19 appeared to have ble immunogenicity in patients with varying degrees of immunocompromised statu tably, ChAdOx1 nCoV-19 has shown promising immunogenicity in ESRD patient HD compared with those undergoing kidney transplantation [33]. Similarly, ChA nCoV-19 did not work well in heart transplant recipients [34].…”

“…ChAdOx1 nCoV-19 appeared to have variable immunogenicity in patients with varying degrees of immunocompromised status. Notably, ChAdOx1 nCoV-19 has shown promising immunogenicity in ESRD patients with HD compared with those undergoing kidney transplantation [33]. Similarly, ChAdOx1 nCoV-19 did not work well in heart transplant recipients [34].…”

Impact of the COVID-19 pandemic on the kidney community: lessons learned and future directions

“…Although immunosuppressed patients and those with kidney disease were excluded from the initial vaccine trials, significant real-world experience has been gained in these groups. Studies of immunogenicity after vaccination revealed poor humoral responses to two doses of both mRNA and viral vector vaccines 73 , 74 . Older age, impaired allograft function, and use of triple maintenance immunosuppression, belatacept, steroids and anti-metabolites were associated with poor humoral response.…”

An additional dose of viral vector COVID-19 vaccine and mRNA COVID-19 vaccine in kidney transplant recipients: A randomized controlled trial (CVIM 4 study)

“…In settings where an inactivated or viral vector COVID‐19 vaccine was initially implemented, inadequate immune responses were noted, particularly in KT recipients. 4 , 19 We finally reached close to 70% seroconversion in our cohort by achieving seroconversion in half of the previously non‐responsive individuals. A study in immunocompetent individuals revealed that the use of an mRNA‐based COVID‐19 vaccine as a booster dose could induce stronger immune responses compared with the use of vaccines from other platforms in nations where the population was immunized with the standard two doses of ChAdOx1 nCoV‐19 vaccine.…”

“…Previous studies have shown that high therapeutic doses of MPA, defined as >1 g/day of MMF or >720 mg/day of MPS, can blunt the immune response induced by the primary series of inactivated, viral vector, or mRNA COVID‐19 vaccines in KT recipients. 4 , 19 , 21 Here, we further explored potential predictors of failed seroconversion after an additional dose of COVID‐19 vaccine. Although a high therapeutic dose of MPA was not associated with poor seroconversion in our study, a slight trend toward lower immune responses in those maintained on an MPA‐based regimen was observed.…”