Humoral Response after SARS-CoV-2 mRNA Vaccination in a Cohort of Hemodialysis Patients and Kidney Transplant Recipients

Abstract

Background Kidney transplant recipients and patients receiving hemodialysis are immunocompromised populations that are prioritized for COVID-19 vaccination but were excluded from clinical trials of SARS-CoV-2 mRNA vaccines. Antibody titers and rates of seroconversion following vaccination are lower among patients with chronic kidney disease and those taking immunosuppressants compared with controls. Data are lacking regarding their humoral response to vaccination to prevent COVID-19. Methods This investigation of early serological response after COVID-19 vaccination with the Pfizer/BioNTech (BNT162b2) mRNA vaccine included 78 patients undergoing hemodialysis, 74 kidney transplant recipients, and 7 healthy controls. We recorded data from the medical file for various clinical parameters, including response to hepatitis B vaccination, and measured antibody titers against SARS-CoV-2 at 0, 14, 28, 36 and 58 days after the first injection. Results In controls, we detected antibodies at a positive level (>13 arbitrary units per milliliter [AU/ml]) at day 14 postinjection, which increased progressively to peak at day 36 (1082 AU/ml; interquartile range [IQR], 735.0-1662.0]). Patients undergoing hemodialysis had lower titers that peaked at day 58 (276 AU/ml [IQR, 83.4-526.0]. We detected a positive antibody level in only three transplant recipients at day 36. In hemodialysis patients, those younger than 75 years had a higher antibody response versus those older than 75 years and serum albumin and Kt/V were positively correlated with serological response (P< 0.043 and P<0.019, respectively); nonresponders to HBV vaccine had the lowest anti-SARS-CoV-2 antibody titers. Conclusions Our results suggest that the postvaccination humoral response is strongly inhibited by immunosuppressant therapy in kidney transplant recipients and is reduced by the uremic condition in patients undergoing hemodialysis.

SARS-CoV-2 Infection in Fully Vaccinated Individuals of Old Age Strongly Boosts the Humoral Immune Response

“…Despite these positive effects of vaccination, however, there are still groups of people in whom the vaccination response is reduced. These include patients with certain diseases or treatment associated with a reduced immune response, such as renal failure requiring dialysis or immunosuppressive therapy after organ transplantation (10)(11)(12). Notably, the vaccine response is also reduced in persons of advanced age.…”

Update zu: Erfahrungen aus dem deutschen COVID-19-Register

“…Dialysepflichtige Patienten entwickelten später und niedrigere Antikörperspiegel als gesunde Personen. Dieser Befund war v. a. bei älteren Patienten ausgeprägt [ 6 ]. Auf der anderen Seite zeigte eine weitere Studie, dass dialysepflichtige Patienten nach mRNA-Impfung eine gute spezifische T‑Zell-Antwort aufbauen können [ 7 ].…”

B and T cell responses after a third dose of SARS-CoV-2 vaccine in Kidney Transplant Recipients

“…Vaccines against SARS-CoV-2 have proven high effectiveness among at-risk populations such as the elderly 1 , patients on maintenance hemodialysis 2 or individuals suffering from chronic inflammatory diseases under selected immunosuppressive regimens 3 . In contrast to the latter, kidney transplant recipients (KTR) receiving immunosuppressive medication exhibit strongly reduced humoral as well as impaired B and T cell responses after mRNA-based vaccination [4][5][6] .…”