Humoral and cellular immune response to severe acute respiratory syndrome coronavirus‐2 vaccination in haemodialysis and kidney transplant patients

Abstract

End‐stage renal disease (ESRD) patients are amongst the vulnerable groups and thus prioritized in the Coronavirus disease‐2019 vaccination programmes. However, this cohort was excluded from vaccine‐trials and yet shares the same vaccination scheme with the general population. Here, we explore trends of immune response‐proportions amongst ESRD patients on renal replacement therapy for up to 4 weeks post‐vaccination completion with Pfizer/Moderna vaccines. From inception to 10 July 2021, we searched six online‐databases for articles reporting humoral and cellular immune response proportions for up to 4 weeks post booster‐vaccination. We pooled the responders' proportions by meta‐analysis and conducted a meta‐regression stratifying outcomes by significant confounders. Twenty‐seven eligible studies reported 2789 ESRD patients. 1337, 1452 and 477 were on haemodialysis, received kidney transplantation, and healthy controls, respectively. Haemodialysis patients' proportions of humoral and cellular immune responses varied from 87.29% (80.77–93.81)–88.78% (86.76–90.80) and 62.86% (56.56, 69.17)–85.78% (78.99, 92.57), respectively, between first‐ and fourth‐weeks. Kidney transplant patients' proportions of humoral and cellular immune responses ranged from 2.6% (0.06–13.48)–29.87% (27.68, 32.07) and 5.13% (0.63–17.3)–59.84% (54.57–65.10), respectively, between first‐ and fourth‐weeks. All healthy controls maintained ≥93% proportions of both responses throughout the follow‐up. Study design and country of study influenced the pooled response proportions. Conclusively, haemodialysis and kidney transplant patients have lower proportions of humoral and cellular immune responses than healthy controls. However, haemodialysis patients' response proportions improve, reaching near healthy‐control levels by the fourth week. Kidney transplant patients' lower responses' proportions also improve but remain significantly lower than healthy controls throughout four‐weeks. The “ one‐size‐fits‐all ” vaccination scheme might be inadequate for kidney transplant patients.

Neutralizing Antibody Activity Against the B.1.617.2 (delta) Variant Before and After a Third BNT162b2 Vaccine Dose in Hemodialysis Patients

“…The missing significance in seroconversion rates when comparing hemodialysis patients with and without immunosuppressive maintenance therapy may be fully explained by the fact that the immunosuppressed patients in our cohort received only low-dose immunosuppression. It has been demonstrated that seroconversion rates after COVID-19 vaccination are higher for hemodialysis patients when compared to solid organ transplant recipients (34,35). In solid organ transplant recipients, immunosuppressive drug number and type are major risk factors of seroconversion failure (34).…”

“…In solid organ transplant recipients, immunosuppressive drug number and type are major risk factors of seroconversion failure (34). As a significant proportion of solid organ transplant recipients still has impaired seroconversion rates even after a third mRNA vaccine dose, individualized vaccine protocols seem necessary for these vulnerable patients and vaccination prior to transplantation appears mandatory (18,(35)(36)(37)(38)(39)(40)(41)(42).…”

Predictive factors of a viral neutralizing humoral response after a third dose of COVID-19 mRNA vaccine

“…A third limitation of our study is the fact that the evaluation of the response to D2 and D3 was made at a single time point, 7–14 days after vaccine injection. One can argue that, although this time point is ideal for the assessment of cellular responses, it could be too early to evaluate humoral responses, especially in KTRs in whom these responses may be delayed 39,40 . However, delayed humoral response in vaccinated KTRs has not been observed by all investigators.…”

B Cell Composition Is Altered After Kidney Transplantation and Transitional B Cells Correlate With SARS-CoV-2 Vaccination Response

“…Accordingly, numerous studies have monitored BCs after transplantation in search of potential biomarkers for graft rejection (7,8) and tolerance (29), respectively. On the other hand, few have tried to find a connection between BCs and vaccination success in KT (30), even though the problem of low serological response after transplantation is well known (19) and has become imminent during the COVID-19 pandemic (31).…”