Immunogenicity, Safety, and Clinical Effectiveness After 2 Doses of BNT162b2 Vaccine Among Pediatric Kidney Transplant Recipients Versus Healthy Volunteers: A Prospective Nonrandomized Study

Medina-Pestana, José; Martins, Suelen Bianca Stopa; Custódio, Luciana de Fátima Porini; Rissoni, Renata Aparecida Pimentel; Dreige, Yasmim Cardoso; Nakamura, Monica Rika; Amorim, Laysla Verhalen Pouzo; Chow, Charles Yea Zen; Tedesco‐Silva, Hélio; Cristelli, Marina Pontello

doi:10.1097/tp.0000000000004498

Cited by 3 publications

(3 citation statements)

References 4 publications

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“…The current published data showed variable humoral immune responses after the COVID‐19 vaccine in kidney transplant recipients with seroconversion rates as high as 91% and as low as 50% after the second dose 15–19 …”

Section: Discussionmentioning

confidence: 97%

The humoral immune response to the BNT 162B2 vaccine in pediatrics on renal replacement therapy

Alshami,

Bahbah,

Al Attas

et al. 2024

Pediatric Transplantation

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IntroductionSince the start of the COVID‐19 pandemic, data published on the immunogenicity of the SARS‐CoV‐2 BNT 162B2 vaccine in pediatric patients receiving renal replacement therapy are scant. Our primary objective is to study this population's humoral immune response to the COVID‐19 vaccine.MethodsPediatric kidney transplant recipients (PKTRs) and hemodialysis recipients (HR) at our center who received two doses of the SARS‐CoV‐2 BNT 162B2 vaccine were included. Transplant and HR who had PCR‐positive COVID‐19 infections during the study, regardless of their vaccine status, were also included. SARS‐CoV‐2 anti‐spike protein (S1/S2) IgG was measured after the second dose of the vaccine and after any PCR‐positive COVID‐19 infection as routine clinical practice. Data on demographics, induction, maintenance immunosuppressants, type of transplant, and posttransplant or dialysis duration were included.ResultsOf the 61 patients included, 19 were dialysis recipients who received two doses of vaccine without subsequent infection (HV), and 42 were kidney transplant recipients. All dialysis patients and 33 (78.6%) transplant recipients received two doses of the SARS‐CoV‐2 BNT 162b2 vaccine. A total of 33.3% (11/33) of the transplant recipients who received vaccination developed COVID‐19 infection (KTH) at a median time of 13 days after the second dose of vaccine. Nine transplant patients had pure COVID‐19 infection without vaccination (KTI). The seroconversion rate in the HV group was 94.7% (18/19) compared to 50% (11/22) in the kidney transplant vaccine recipients who did not develop subsequent COVID‐19 infection (KTV) (p < .001). The median S1/S2 IgG titers for the HV group were 400 AU/mL versus 15 AU/mL in the KTV group (p < .0001). There was no significant difference in the duration of the test from the second dose of the vaccine between HV and KTV (55 vs. 33.5 days, p = .095). The KTH had higher titers than KTV group (370 vs. 15 p < .0001). The median duration of the test after vaccination in the vaccine group and those with hybrid immunity was similar (35 vs. 33.5 days, p = .2).There were no clear predictors for seroconversion in the PKTRs. Natural infection alone was as good as the vaccine in eliciting humoral immune response.ConclusionThe humoral immune response to two doses of the SARS‐CoV‐2 BNT 162B2 vaccine in PKTRs without subsequent COVID‐19 infection is suboptimal compared to that in hemodialysis recipients and in PKTRs with hybrid immunity from both infection and vaccination.

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Section: Discussionmentioning

confidence: 97%

The humoral immune response to the BNT 162B2 vaccine in pediatrics on renal replacement therapy

Alshami,

Bahbah,

Al Attas

et al. 2024

Pediatric Transplantation

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show abstract

“…Our present study also revealed that even low antibody titers, below the seroprotection level, could protect against severe COVID-19. Similarly, Medina-Pestana et al [26] reported that even when pediatric KTRs developed a breakthrough infection after their second vaccine dose, none of them required hospitalization. It should also be noted that the omicron variant of SARS-CoV-2 was the most predominant local strain during our present study.…”

Section: Discussionmentioning

confidence: 99%

Inter- and intra-individual differences regarding SARS-CoV-2 and influenza vaccination in pediatric kidney transplant recipients: An observational study

Kanai,

Ito,

Saito

et al. 2024

Medicine

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In kidney transplant recipients (KTRs), viral infection can lead to antibody and/or T-cell mediated rejection, resulting in kidney transplant dysfunction. Therefore, it is critical to prevent infections. However, KTRs exhibit suboptimal responses to SARS-CoV-2 and/or influenza vaccines, partly due to immunosuppressant therapy. Inter- and intra-individual differences in the biological responses to vaccines may also affect patients’ antibody production ability. This study included KTRs who received an messenger RNA SARS-CoV-2 vaccine (3 doses), and an inactivated quadrivalent influenza vaccine (1 or 2 doses). We measured the patients’ total antibody titers against SARS-CoV-2 spike antigen, and hemagglutination inhibition (HI) titers against influenza A/H1N1, A/H3N2, B/Yamagata, and B/Victoria. Five patients were eligible for this study. Of these 5 KTRs, two produced anti-SARS-CoV-2 spike antibody titers to a seroprotective level, and also produced HI titers against A/H1N1 to a seroprotective level. Another 2 KTRs did not produce seroprotective anti-SARS-CoV-2 antibody titers, but produced seroprotective HI titers against A/H1N1. The remaining KTR produced a seroprotective anti-SARS-CoV-2 antibody titer, but did not produce a seroprotective HI titer against A/H1N1. The 2 KTRs who did not produce seroprotective anti-SARS-CoV-2 antibody titers following vaccination, later developed COVID-19, and this infection increased their titers over the seroprotective level. This study demonstrated that inter- and intra-individual differences in biological responses to vaccines should be considered in pediatric KTRs, in addition to immunosuppressant effects. Personalized regimens, such as augmented or booster doses of vaccines, could potentially improve the vaccination efficacy against SARS-CoV-2 and influenza.

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“…In a study of pediatric and adolescent KTRs, the third dose of an mRNA vaccine increased seroconversion from 56% after the second dose to 85%; in 16 patients who did not seroconvert with the second dose, 12 (75%) successfully developed antibodies with the third dose [ 54 ]. These data were impressive, in contrast to studies in adult KTRs [ 55 ].…”

Section: Immunosuppression and Vaccine Response In Solid Organ Transp...mentioning

confidence: 99%

Measures to Increase Immunogenicity of SARS-CoV-2 Vaccines in Solid Organ Transplant Recipients: A Narrative Review

Yu,

Tamargo,

Brennan

et al. 2023

Vaccines

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Purpose of review: To review the data on the immunogenicity of COVID-19 vaccines, administered by different strategies, in solid organ transplant recipients (SOTRs). Recent findings: COVID-19 booster vaccines were given to SOTRs as a widespread practice in many transplant centers, mostly as the third and/or fourth dose in an extended vaccine series, with a significantly improved humoral response compared with the initial two-dose scheme. However, one-third of SOTRs remained unresponsive, despite these boosters. Next steps: Vaccination with standard dosing remains the most feasible strategy for attaining protection against COVID-19. Additional booster doses and temporarily holding or reducing mycophenolate mofetil/mycophenolic acid may provide immunogenicity to vaccines, according to recent studies demonstrating some efficacy with these measures. Preexposure prophylaxis with monoclonal antibodies showed benefit in immunocompromised patients but is no longer recommended by the National Institutes of Health (NIH) due to diminished efficacy against Omicron and recent variants. Screening for the presence and titers of SARS-CoV-2-specific antibodies in SOTRs is not recommended in most clinical settings. T cell-based techniques are needed to evaluate vaccine efficacy and risk of infection. As SARS-CoV-2 continues to evolve, new vaccines based on conservative protein component/complexes of the COVID virus, in addition to its spike protein, are warranted to offer prolonged protection.

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Immunogenicity, Safety, and Clinical Effectiveness After 2 Doses of BNT162b2 Vaccine Among Pediatric Kidney Transplant Recipients Versus Healthy Volunteers: A Prospective Nonrandomized Study

Cited by 3 publications

References 4 publications

The humoral immune response to the BNT 162B2 vaccine in pediatrics on renal replacement therapy

The humoral immune response to the BNT 162B2 vaccine in pediatrics on renal replacement therapy

Inter- and intra-individual differences regarding SARS-CoV-2 and influenza vaccination in pediatric kidney transplant recipients: An observational study

Measures to Increase Immunogenicity of SARS-CoV-2 Vaccines in Solid Organ Transplant Recipients: A Narrative Review

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