Immune Response after SARS-CoV-2 Vaccination in Kidney Transplant Patients

Abstract

Background and Objectives: The prospective study was conducted to evaluate humoral and cellular immune responses after two doses of BNT162b2 (Pfizer-BioNTech) vaccine and possible relation with other factors (medication, etc.) in kidney transplant patients. Materials and Methods: Out of 167 vaccinated patients, 136 agreed to a follow-up visit three to six weeks after vaccination. Results: Only 39 patients (29%) developed antibody response against SARS-CoV-2 (≥35.2 binding antibody units (BAU)/mL) after full vaccination. Multivariate binary logistic regression analysis showed that predictive factors for good antibody response to the COVID-19 vaccine were better kidney function, higher hemoglobin level, and no use of mycophenolate mofetil for immunosuppression. For seropositive kidney transplant patients there was a significant negative correlation between anti-SARS-CoV-2 antibody titer and CD4/CD8 ratio (Spearman’s correlation coefficient −0.4, p = 0.02), percentage of CD19+ cells (r = −0.37, p = 0.02), and a positive correlation with percentage of CD8+ cells (r = 0.4, p = 0.01). There was an increase of total leucocyte count after vaccination in the total studied population, and in the group of responders. Conclusions: Only one third of kidney transplant patients develop sufficient antibody responses after full COVID-19 vaccination with Pfizer-BioNTech. Better kidney function, higher hemoglobin level, and no use of mycophenolate mofetil for immunosuppression increases the adequacy of response. The antibody titers correlated positively with relative number of CD8+ cells and negatively with CD4/CD8 ratio in responders.

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

“…Studies have shown that the use of mycophenolate mofetil significantly hampers the seroconversion after vaccination in RTRs (5,20). All our patients were on mycophenolate mofetil at the time of sampling.…”

“…The poor seroconversion is expected in RTRs because of an immunocompromised state because of immunosuppressions like calcineurin inhibitors, mycophenolate mofetil, and corticosteroids. Studies have shown that the use of mycophenolate mofetil significantly hampers the seroconversion after vaccination in RTRs ( 5 , 20 ). All our patients were on mycophenolate mofetil at the time of sampling.…”

“…Well-validated mRNAbased vaccines BNT162b2 (Pfizer-BioNTech, USA) are mainly limited to developed countries. The vaccines have shown high seroconversion rate in the general population up to the tune of 95%, however, had a poor seroconversion rate in renal transplant recipient (RTR) (5)(6)(7). Data of mRNA-based vaccination showed a 48% of seroconversion rate in RTRs after the 28 th day of the 2 nd dose of vaccination (1,6,8).…”

Renal Complications in Kidney Transplant Recipients After Whole-virus Inactivated COVID-19 Vaccination

“…5 Vaiciuniene et al reported 6 biopsy-confirmed ARs in 167 fully vaccinated KT recipients with mRNA vaccine in 9 mo follow-up. 2 Our results provided the safety profile of the whole-virus inactivated COVID-19 vaccine in KTs, suggesting that more intensive monitoring of graft function after vaccination was necessary. Notably, due to lack of matched control group and ascertainment bias, it remains unclear whether there is casual association between renal complications and vaccination.…”

“…Prevaccination eGFR, mL/min/1.73m 2 Boyarsky et al reported that 1 of 176 experienced AR after receiving 2 doses of mRNA vaccines. 5 Vaiciuniene et al reported 6 biopsy-confirmed ARs in 167 fully vaccinated KT recipients with mRNA vaccine in 9 mo follow-up.…”