Humoral Immune Response of SARS-CoV-2 Infection and Anti-SARS-CoV-2 Vaccination in Renal Transplant Recipients

Abstract

Vaccination-induced SARS-CoV-2 neutralizing antibodies are required for herd immunity. Vaccine availability and poor vaccine response in renal transplant recipients (RTRs) remain a concern. There is no report on the efficacy of Covaxin and Covishield vaccines in RTRs. We recruited 222 live donors RTRs and analyzed the serum titer of anti-SARS-CoV-2 spike protein antibody by chemiluminescent magnetic microparticle immunoassay. Patients were categorized into three groups: group1 with SARS-CoV-2 infection and no vaccination (n = 161); group 2 with only vaccination and no SARS-CoV-2 infection (n = 41); and group 3 with both vaccination and SARS-CoV-2 infection (n = 20). Overall seroconversion rate was 193/222 (86.9%) with a median titer 1095.20 AU/mL. The median IgG titer value in group 1 was 647.0 AU/mL; group 2 was 1409.0 AU/mL; and group 3 was 1831.30 AU/mL. Covaxin associated seroconversion was observed in 16/19 (84.21%), with a median titer of 1373.90 AU/mL compared to that of Covishield 32/42 (76.19%), whose median titer was 1831.10 AU/mL. The seroconversion rate due to SARS-CoV-2 infection was 145 (90.06%), it was lowest with the vaccination-only group (70.7%), and with both vaccination and SARS-CoV-2 infection group it was highest (95%). In RTRs, SARS-CoV-2 infection and both Covaxin and Covishield vaccination effectively induce a humoral immune response against the SARS-CoV-2 spike protein; however, seroconversion rate was lower and the antibody titer was higher with vaccine than infection.

Seroconversion Rate After SARS-CoV-2 Infection and Two Doses of Either ChAdOx1-nCOV COVISHIELD™ or BBV-152 COVAXIN™ Vaccination in Renal Allograft Recipients: An Experience of Two Public and Private Tertiary Care Center

“…Alternatively, using more antigenic material in vaccine preparation may improve the vaccine efficacy for these patients. The present two-center study confirms the finding of our single-center study of higher seroconversion rate with COVISHIELD™ and COVAXIN™ in living donor renal transplant patients in India ( 10 ). The side-effects profile suggests the safety of these vaccines in RTRs.…”

“…The lower antibody titer may be due to the waning of the antibody over time ( 3 , 37 ). It is speculated that whole virus-based vaccines may induce the robust seroconversion and elicitation of antibody titer as reflected in our finding ( Table 2 ) ( 10 ).…”

“…However, the seroconversion data is limited to a small single-center study in RTRs ( 9 ). A single-center study showed seroconversion of about 70% in RTRs, which is higher than that reported from mRNA-based vaccines ( 1 , 10 ). A lesser amount of antibody formation and poor seroconversion rate after vaccination and SARS-CoV-2 infection is expected in RTRs because of immunosuppressive medicines ( 1 , 6 , 7 ).…”

Antibody Response to ChAdOx1 nCoV-19 (AZD1222) Vaccine in Kidney Transplant Recipients

“…Our study has shown that a large proportion of KTRs had an asymptomatic infection before vaccination. The balance of participants with asymptomatic infection was 78% in our study, which is comparable to 90% found by Prasad et al in another Indian study [ 12 ]. A large study has shown that 90% of infections in India are asymptomatic [ 13 ].…”

COVID-19: A nephrologists' perspective

“…Vaccine response to mRNA vaccines is poor in organ transplant recipients. [ 54 ] However, one published[ 55 ] and our unpublished data from India have shown excellent seroconversion rates (>80%) even with single dose of Oxford-Astra Zeneca vaccine. This may be related to the younger age, lower comorbidity burden, and possibly high rates of symptomatic and subclinical infection.…”