Reduced humoral response to mRNA SARS-CoV-2 BNT162b2 vaccine in kidney transplant recipients without prior exposure to the virus

Abstract

COVID‐19 is associated with increased morbidity and mortality in transplant recipients. There are no efficacy data available regarding these patients with any of the available SARS‐CoV‐2 vaccines. We analyzed the humoral response following full vaccination with the BNT162b2 (Pfizer‐BioNTech) in 136 kidney transplant recipients, and compared it to 25 controls. In order to exclude prior exposure to the virus, only participants with negative serology to SARS‐CoV‐2 nucleocapsid protein were included. All controls developed a positive response to spike protein, while only 51 of 136 transplant recipients (37.5%) had positive serology (p < .001). Mean IgG anti‐spike level was higher in the controls (31.05 [41.8] vs. 200.5 [65.1] AU/mL, study vs. control, respectively, p < .001). Variables associated with null humoral response were older age (odds ratio 1.66 [95% confidence interval 1.17–2.69]), high‐dose corticosteroids in the last 12 months (1.3 [1.09–1.86]), maintenance with triple immunosuppression (1.43 [1.06–2.15]), and regimen that includes mycophenolate (1.47 [1.26–2.27]). There was a similar rate of side effects between controls and recipients, and no correlation was found between the presence of symptoms and seroconversion. Our findings suggest that most kidney transplant recipients remain at high risk for COVID‐19 despite vaccination. Further studies regarding possible measures to increase recipient's response to vaccination are required.

Protected or not protected, that is the question - First data on COVID-19 vaccine responses in patients with NAFLD and liver transplant recipients

“…Importantly, the authors reported no serious adverse events associated with the vaccine, and no event of graft rejection was observed. This is consistent with other early real-world reports in transplant recipients vaccinated with Moderna or BioNTech/Pfizer mRNA vaccines, in whom similarly no graft rejections were observed during the early follow-up period [5,6].…”

“…The same group evaluated vaccine responses in 136 kidney transplant recipients (KTR) and reported even lower antibody responses following vaccination with BNT162b2 and only 37.5% of KTR had detectable SARS-CoV-2 specific antibodies [5]. Compared to LTR, seropositivity rates and mean antibody titers were lower in KTR [5], matching previous J o u r n a l P r e -p r o o f reports that transplant recipients other than LTR generally have a lower humoral response to vaccination [7]. This may be due to distinct immunosuppressive treatments used in different transplant groups.…”

“…This may be due to distinct immunosuppressive treatments used in different transplant groups. Indeed, predictors of absence of humoral vaccine responses in both LTR [3] and KTR [5] were treatment with high-dose steroids and anti-metabolites (i.e. mycophenolate mofetil), in addition to older age and for LTR lower eGFR.…”

Subcutaneous REGEN-COV Antibody Combination for Covid-19 Prevention

“…Millions in the US alone suffer from either a primary or secondary immune deficiency; recent studies show that the majority of such patients mount insufficient response to vaccines. [11][12][13] Additionally, immunosenescence may . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.…”

Getting the COVID-19 vaccine as a transplant patient

“…More recent studies from around the globe support the earlier findings that response to vaccines is low in the immunosuppressed, but the studies had small numbers of patients. [7][8][9] The second part of the Hopkins study showed slightly more promise after the second dose of the vaccine. 4 We still need more clinical data, but how quickly will it arrive?…”