Declined Humoral Immunity of Kidney Transplant Recipients to SARS-CoV-2 Vaccines

Abstract

Background Kidney transplant recipients (KTRs) commonly suffer from impaired immunity. KTRs’ compromised immune response to COVID-19 vaccines indicates urgent revision of immunisation policies. Methods A cross-sectional study was conducted in Madinah, Saudi Arabia of 84 KTRs who had received at least one dose of a COVID-19 vaccine. ELISA was used to evaluate anti-spike SARS-CoV-2 IgG and IgM antibody levels in blood samples obtained one month and seven months after vaccination. Univariate and multivariate analyses were performed to identify associations between seropositive status and factors such as the number of vaccine doses, transplant age, and immunosuppressive therapies. Results The mean age of KTRs was 44.3 ± 14.7 years. The IgG antibody seropositivity rate (n=66, 78.5%) was significantly higher than the seronegativity rate (n=18, 21.4%) in the whole cohort (p<0.001). In KTRs seroconverting after one month (n=66), anti-SARS-CoV-2 IgG levels declined significantly between one month (median [IQR]:3 [3–3]) and seven months (2.4 [1.7–2.6]) after vaccination (p<0.01). In KTRs with hypertension, IgG levels significantly decreased between one and seven months after vaccination (p<0.01). IgG levels also decreased significantly in KTRs with a transplant of >10 years (p=0.02). Maintenance immunosuppressive regimens (triple immunosuppressive therapy and steroid-based and antimetabolite-based regimens) led to a significant decrease in IgG levels between the first and second sample (p<0.01). KTRs receiving three vaccine doses showed higher antibody levels than those receiving a single dose or two doses, but the levels decreased significantly between one (median [IQR]: 3 [3–3]) and seven months (2.4 [1.9–2.6]) after vaccination (p<0.01). Conclusion KTRs’ humoral response after SARS-CoV-2 vaccination is dramatically inhibited and wanes. Antibody levels show a significant decline over time in KTRs with hypertension; receiving triple immunosuppressive therapy or steroid-based or antimetabolite-based regimens; receiving mixed mRNA and viral vector vaccines; and with a transplant of >10 years.

Impaired humoral immune response to hepatitis B vaccine in patients on maintenance hemodialysis

“…( Phattraprayoon et al, 2022 ). Additionally, kidney transplant recipients who were vaccinated with COVID-19 vaccines showed a significant and dramatic decline of antibody levels over time ( Mahallawi et al, 2023 ).…”

Humoral and Cellular Immunological Response in Patients with Kidney Transplantation After messenger-RNA-COVID-19 Vaccination: A Systematic Review and Meta-Analysis

“…Interestingly, a recent study demonstrated that viral-vector, and heterogenous of all homogenous mRNA-COVID-19 vaccines revealed reduction of levels of anti-S1 IgG between the first and third serum samples [18]. No differences between serum anti-S1 IgG levels at one and six-months after mRNA-COVID-19 vaccination in KTRs with one-month-post-mRNA-COVID-19vaccination-IgG-immune-response seropositivity and different factors through linear regression analysis [18]. Among the immunocompromised population, including KTRs, DPs, PDs, at least three doses of mRNA-COVID-19 vaccination was recommended to be the preparation of choice [20,22].…”