Determinants of Immune Response to Anti–SARS-CoV-2 mRNA Vaccines in Kidney Transplant Recipients: A Prospective Cohort Study

Magicova, Maria; Zahradka, Ivan; Fialová, Markéta; Neskudla, Tomas; Gurka, Jiří; Módos, István; Hojny, M; Raska, Petr; Šmejkal, Petr; Střı́ž, Ilja; Viklický, Ondřej

doi:10.1097/tp.0000000000004044

Cited by 24 publications

(32 citation statements)

References 35 publications

(54 reference statements)

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“…Individualized strategies based on changing immunosuppression in vaccination have been proposed to improve vaccine efficacy, at least in low immunological risk patients or those at a high risk of a severe course of COVID-19. 40 , 42 , 43 Our results also show differences in outcomes between the 2 types of mRNA vaccines. The probability of death was significantly lower in patients fully vaccinated with the mRNA-1273 vaccine after adjusting for other risk factors.…”

Section: Discussionsupporting

confidence: 52%

“… 21 , 22 Specifically, belatacept and mycophenolate have been associated with unresponsiveness. 40 - 42 In patients with severe disease, such as those who required hospitalization, we observed a trend toward a higher risk of COVID-19–related death if they were receiving mycophenolate as maintenance immunosuppression at SARS-CoV-2 infection diagnosis. Individualized strategies based on changing immunosuppression in vaccination have been proposed to improve vaccine efficacy, at least in low immunological risk patients or those at a high risk of a severe course of COVID-19.…”

Section: Discussionmentioning

confidence: 81%

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Breakthrough Infections Following mRNA SARS-CoV-2 Vaccination in Kidney Transplant Recipients

et al. 2022

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Background. The clinical effectiveness of coronavirus disease 2019 (COVID-19) vaccination in kidney transplant (KT) recipients is lower than in the general population. Methods. From April to October 2021, 481 KT recipients with COVID-19, included in the Spanish Society of Nephrology COVID-19 Registry, were analyzed. Data regarding vaccination status and vaccine type were collected, and outcomes of unvaccinated or partially vaccinated patients (n = 130) were compared with fully vaccinated patients (n = 351). Results. Clinical picture was similar and survival analysis showed no differences between groups: 21.7% of fully vaccinated patients and 20.8% of unvaccinated or partially vaccinated died ( P = 0.776). In multivariable analysis, age and pneumonia were independent risk factors for death, whereas vaccination status was not related to mortality. These results remained similar when we excluded patients with partial vaccination, as well as when we analyzed exclusively hospitalized patients. Patients vaccinated with mRNA-1273 (n = 213) showed a significantly lower mortality than those who received the BNT162b2 vaccine (n = 121) (hazard ratio: 0.52; 95% confidence interval, 0.31-0.85; P = 0.010). Conclusions. COVID-19 severity in KT patients has remained high and has not improved despite receiving 2 doses of the mRNA vaccine. The mRNA-1273 vaccine shows higher clinical effectiveness than BNT162b2 in KT recipients with breakthrough infections. Confirmation of these data will require further research taking into account the new variants and the administration of successive vaccine doses.

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Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 81%

Breakthrough Infections Following mRNA SARS-CoV-2 Vaccination in Kidney Transplant Recipients

et al. 2022

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“…Only 1 out of 40 had detectable levels of IgG and this was due to post-COVID-19 disease rather than immunization [ 26 ]. Other reports cite response rates between 36 and 60% [ 27 – 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…Lack of immunologic response after two-dose vaccination in KT recipients has been associated with advanced age (> 60 years), transplantation within 12 months, use of MMF, B cell depletion (e.g. rituximab), and use of non-mRNA vaccines [ 17 – 19 , 29 – 32 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

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Immunologic response to SARS-CoV-2 mRNA vaccination in pediatric kidney transplant recipients

et al. 2022

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Background COVID-19 disease in kidney transplant (KT) recipients is associated with increased morbidity, mortality, and hospitalization rates. Unfortunately, KT recipients also have a reduced response to SARS-CoV-2 immunization. The primary aim of this study was to assess immunologic response to SARS-CoV-2 mRNA vaccines in pediatric kidney transplant recipients 12–18 years of age. Secondary aims were to assess response rates following a third immunization and determine factors that influence immunization response. Methods Pediatric KT recipients in a single tertiary center received SARS-CoV-2 mRNA vaccination as per local protocol. SARS-CoV-2 immunoglobulin (IgG) was measured following second and/or third vaccination. Demographics including patient factors (age, gender, and underlying disease), transplant factors (time and type of transplant), and immunosuppression (induction, maintenance, and immunomodulatory therapies such as IVIG) were collected from the medical records. Results Of 20 participants, 10 (50%) responded following a two-dose vaccine schedule, which increased to 15 (75%) after three doses. Maintenance immunosuppression affected immunologic response, with azathioprine demonstrating a higher rate of response to vaccine compared to mycophenolate (100% vs. 38%, p = 0.04). Increasing prednisolone dose had a negative impact on immunologic response (0.01 mg/kg/day increase: OR 1.60 95% CI 1.01 to 2.57). Tacrolimus dose and trough levels, age, time post-transplant, underlying disease, and other immunosuppression did not impact immunologic response. Conclusions Pediatric KT recipients had similar response rates following SARS-CoV-2 immunization as adult KT recipients. Immunologic response improved following a third immunization. Choice of antimetabolite and prednisolone dosing influenced the rate of response. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary Information Supplementary Information The online version contains supplementary material available at 10.1007/s00467-022-05679-y.

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A prospective humoral immune monitoring study of kidney transplant recipients receiving three doses of SARS‐CoV‐2 mRNA vaccine

Borgogna,

Ferrante,

Rosso

et al. 2024

Journal of Medical Virology

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Kidney transplant recipients (KTRs), like other solid organ transplant recipients display a suboptimal response to mRNA vaccines, with only about half achieving seroconversion after two doses. However, the effectiveness of a booster dose, particularly in generating neutralizing antibodies (NAbs), remains poorly understood, as most studies have mainly focused on non‐neutralizing antibodies. Here, we have longitudinally assessed the humoral response to the SARS‐CoV‐2 mRNA vaccine in 40 KTRs over a year, examining changes in both anti‐spike IgG and NAbs following a booster dose administered about 5 months post‐second dose. We found a significant humoral response increase 5 months post‐booster, a stark contrast to the attenuated response observed after the second dose. Of note, nearly a quarter of participants did not achieve protective plasma levels even after the booster dose. We also found that the higher estimated glomerular filtration rate (eGFR) correlated with a more robust humoral response postvaccination. Altogether, these findings underscore the effectiveness of the booster dose in enhancing durable humoral immunity in KTRs, as evidenced by the protective level of NAbs found in 65% of the patients 5 months post‐ booster, especially those with higher eGFR rates.

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Determinants of Immune Response to Anti–SARS-CoV-2 mRNA Vaccines in Kidney Transplant Recipients: A Prospective Cohort Study

Abstract: This study is registered under the identifier NCT04832841 on ClinicalTrials.gov.

Cited by 24 publications

References 35 publications

Breakthrough Infections Following mRNA SARS-CoV-2 Vaccination in Kidney Transplant Recipients

Breakthrough Infections Following mRNA SARS-CoV-2 Vaccination in Kidney Transplant Recipients

Immunologic response to SARS-CoV-2 mRNA vaccination in pediatric kidney transplant recipients

A prospective humoral immune monitoring study of kidney transplant recipients receiving three doses of SARS‐CoV‐2 mRNA vaccine

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