Persistence of Antibody Responses to the SARS-CoV-2 in Dialysis Patients and Renal Transplant Recipients Recovered from COVID-19

Abstract

Nephropathic subjects with impaired immune responses show dramatically high infection rates of coronavirus disease 2019 (COVID-19). This work evaluated the ability to acquire and maintain protective antibodies over time in 26 hemodialysis patients and 21 kidney transplant recipients. The subjects were followed-up through quantitative determination of circulating SARS-CoV-2 S1/S2 IgG and neutralizing antibodies in the 6-month period after clinical and laboratory recovery. A group of 143 healthcare workers with no underlying chronic pathologies or renal diseases recovered from COVID was also evaluated. In both dialysis and transplanted patients, antibody titers reached a zenith around the 3rd month, and then a decline occurred on average between the 270th and 300th day. Immunocompromised patients who lost antibodies around the 6th month were more common than non-renal subjects, although the difference was not significant (38.5% vs 26.6%). Considering the decay of antibody levels below the positivity threshold (15 AU/mL) as “failure”, a progressive loss of immunisation was found in the overall population starting 6 months after recovery. A longer overall antibody persistence was observed in severe forms of COVID-19 (p = 0.0183), but within each group, given the small number of patients, the difference was not significant (dialysis: p = 0.0702; transplant: p = 0.1899). These data suggest that immunocompromised renal patients recovered from COVID-19 have weakened and heterogeneous humoral responses that tend to decay over time. Despite interindividual variability, an association emerged between antibody persistence and clinical severity, similar to the subjects with preserved immune function.

Antibody Responses after Two Doses of COVID-19 mRNA Vaccine in Dialysis and Kidney Transplantation Patients Recovered from SARS-CoV-2 Infection

“…Recent data from our group confirmed this view, as we described an impaired and heterogeneous humoral protection in dialysis and transplanted patients with previous SARS-CoV-2 infection, which tends to fade between 3 and 6 months after recovery [17].…”

“…Up to now, limited evidence is available on the response to COVID-19 vaccines in immunocompromised nephropathic subjects who previously experienced SARS-CoV-2 infection. Prior research from our group found that HD patients and KTRs that recovered from COVID-19 show a delayed viral clearance, in front of a valuable serological response with a tendency to an earlier decline of antibody titers over time—especially in the asymptomatic or paucisymptomatic cases—compared to the immunocompetent subjects with normal renal function [ 16 , 17 ].…”

Patients receiving hemodialysis do not lose SARS-CoV-2 antibodies more rapidly than non-renal controls: a prospective cohort study

“…found no differences between seropositivity rates after around 6 months from COVID-19 in the mixed cohort of HD and renal transplant recipients, and in the subjects with normal renal function. However, the study was primarily focused on the comparison of SARS-CoV-2 humoral immunity between dialysis and renal transplant recipients, and authors did not compare neither the magnitude nor the dynamics of humoral responses in renal and non-renal groups [ 14 ].…”

The challenge of evaluating of SARS‐CoV‐2 antibody responses among vaccinated transplant patients

“…6 7 This is accentuated by the immunocompromised state of participants. 8 Even if nucleocapsid antibody testing had been All authors meet the ICMJE authorship criteria.…”

“…While the study by Feingold et al reported no presumed cases of SARS‐CoV‐2 infection among their study participants, asymptomatic or mildly symptomatic patients are potentially more likely to have negative antibody responses 7 . This is accentuated by the immunocompromised state of participants 8 . Even if nucleocapsid antibody testing had been undertaken to determine the occurrence of antibodies to the virus as opposed to the vaccine (as discussed below), it has been reported that there is the potential for a muted antibody response leading to the false assumption that no infection occurred.…”