Impaired Immune Response to SARS-CoV-2 Vaccination in Dialysis Patients and in Kidney Transplant Recipients

Abstract

Background: Kidney failure patients on dialysis or after renal transplantation have a high risk for severe COVID-19 infection and vaccination against SARS-CoV-2 is the only expedient prophylaxis. Generally, immune responses are attenuated in kidney failure patients, however, systematic analyses of immune responses to SARS-CoV-2 vaccination in dialysis patients and in kidney transplant recipients (KTR) are still missing. Methods: In this prospective multicentric cohort study, antibody responses COVID-19 mRNA vaccines (BNT162b2; Biontech/Pfizer or mRNA-1273; Moderna) were measured in 32 dialysis patients and in 28 KTRs. SARS-CoV-2-specific antibodies and neutralization capacity were evaluated and compared to controls (n=78) in a similar age-range. Results: After the first vaccination, SARS-CoV-2-specific antibodies were nearly undetectable in kidney failure patients. After the second vaccination, 93% of the controls and 88% of dialysis patients but only 37% of KTRs developed SARS-CoV-2-specific IgG above cut-off. Moreover, mean IgG levels were significantly lower in KTRs (54±93 BAU/ml) compared to dialysis patients (503±481 BAU/ml, p<0.01). Both KTRs as well as dialysis patients had significantly lower IgG levels compared to controls (1992±2485 BAU/ml; p<0.001 and p<0.01). Importantly, compared to controls, neutralizing antibody titers were significantly lower in KTRs and dialysis patients. After the second vaccination, 76% of KTRs did not show any neutralization capacity against SARS-CoV-2 suggesting impaired seroprotection. Conclusions: Kidney failure patients show a significantly weaker antibody response compared to controls. Most strikingly, only one out four KTRs developed neutralizing antibodies against SARS-CoV-2 after two doses of vaccine. These data suggest that vaccination strategies need modification in immune transplant and dialysis patients.

Seroprevalence of SARS-CoV-2 spike IgG antibodies after the second BNT162b2 mRNA vaccine in Japanese kidney transplant recipients

“…Korh et al and Danthu et al reported anti-SARS-CoV-2 IgG seroprevalence rates of 22% (5/23) and 4.1% (3/74), respectively, in KT recipients, based on the LIAISON® SARS-CoV-2 Trimetric-S IgG assay (Diasorin, Italy) with a positive cutoff value of 13.0 arbitrary units/mL 3 , 7 . Kolb et al reported a seroprevalence of 37% (10/28) using the Anti-SARS-CoV-2 QuantiVac ELISA for spike protein (Euroimmun, Germany) with a positive cutoff value of 35.2 binding antibody units/mL 6 . Benomane et al and Bertrand et al reported seroprevalence rates of 40.3% (64/159) and 17.8% (8/45 recipients), respectively, using the ARCHITECT ® IgG II Quant test for spike protein (Abbott Laboratories) with a positive cutoff value of 50.0 arbitrary units/mL 2 , 5 .…”

Intensity of mycophenolate mofetil treatment is associated with an impaired immune response to SARS-CoV-2 vaccination in kidney transplant recipients

“… 8 Twenty‐eight of the 225 KTRs were included in a previously published study. 9 All participants had to be older than 18 years, with no history of previous COVID‐19 and able to give informed consent to participate in the study. All KTRs were on stable immunosuppressive medication.…”

“…Shortly, the previously described control group was composed of volunteers from a nursing home, who had no history of kidney failure 8 . Twenty‐eight of the 225 KTRs were included in a previously published study 9 . All participants had to be older than 18 years, with no history of previous COVID‐19 and able to give informed consent to participate in the study.…”

“…8 Twenty-eight of the 225 KTRs were included in a previously published study. 9 All participants had to be older than 18 Hospital Düsseldorf, Germany. According to the manufacturer's instruction results <25.6 BAU/ml were considered as negative, ≥25.6 BAU/ml and ≤35.2 BAU/ml as indeterminate, and >35.2 BAU/ ml as positive (BAU, Binding Antibody Units).…”

Anti-SARS-CoV-2 Antibody Level among Renal Transplant Recipients: A Case Report from Nepal

“…Globally, as of 7th January 2022, 137 different COVID-19 vaccines are in various phases of clinical trials, while 194 are in the preclinical phase; emergency-use approved vaccines are recommended prioritizing people with chronic diseases, with certain clinical conditions and old age [ 8 ]. Studies have reported that vaccines show weak immunogenicity among kidney transplant recipients as they do not produce antibodies effectively [ 9 , 10 ]. Moreover, live or replication component vaccines are contraindicated in transplant recipients [ 11 ].…”