The type of SARS‐CoV‐2 vaccine influences serological response in kidney transplant recipients

Correia, Ana Luísa; Leal, Rita; Pimenta, Ana Carolina; Fernandes, Mariana; Marques, Maria Guedes; Rodrigues, Luís; Santos, Lídia; Romãozinho, Catarina; Sá, Helena; Pratas, Jorge; Araújo, Lucília; Figueiredo, Arnaldo; Alves, Rui

doi:10.1111/ctr.14585

Cited by 15 publications

(17 citation statements)

References 15 publications

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“…Interestingly, time post-transplantation did not affect the response rates in this cohort as has been demonstrated in previous studies with vaccination within 12 months of transplantation negatively impacting immunologic response [ 20 ]. The use of rituximab, tocilizumab, IVIG, and/or ATG also did not influence immune response in this cohort; however, the sample sizes for these factors were small.…”

Section: Discussionsupporting

confidence: 56%

“…There is little data in pediatric KT recipients; however, several small cohort studies of adolescents and young adults have demonstrated similar absence of antibodies post-SARS-COV-2 immunizations [ 18 , 19 ]. Factors associated with poor response rates following a two-dose vaccination schedule include advanced age, immunization within 12 months of transplantation, non-mRNA vaccines, use of mycophenolate mofetil (MMF), or use of more than two immunosuppressant agents [ 17 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

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Immunologic response to SARS-CoV-2 mRNA vaccination in pediatric kidney transplant recipients

et al. 2022

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Background COVID-19 disease in kidney transplant (KT) recipients is associated with increased morbidity, mortality, and hospitalization rates. Unfortunately, KT recipients also have a reduced response to SARS-CoV-2 immunization. The primary aim of this study was to assess immunologic response to SARS-CoV-2 mRNA vaccines in pediatric kidney transplant recipients 12–18 years of age. Secondary aims were to assess response rates following a third immunization and determine factors that influence immunization response. Methods Pediatric KT recipients in a single tertiary center received SARS-CoV-2 mRNA vaccination as per local protocol. SARS-CoV-2 immunoglobulin (IgG) was measured following second and/or third vaccination. Demographics including patient factors (age, gender, and underlying disease), transplant factors (time and type of transplant), and immunosuppression (induction, maintenance, and immunomodulatory therapies such as IVIG) were collected from the medical records. Results Of 20 participants, 10 (50%) responded following a two-dose vaccine schedule, which increased to 15 (75%) after three doses. Maintenance immunosuppression affected immunologic response, with azathioprine demonstrating a higher rate of response to vaccine compared to mycophenolate (100% vs. 38%, p = 0.04). Increasing prednisolone dose had a negative impact on immunologic response (0.01 mg/kg/day increase: OR 1.60 95% CI 1.01 to 2.57). Tacrolimus dose and trough levels, age, time post-transplant, underlying disease, and other immunosuppression did not impact immunologic response. Conclusions Pediatric KT recipients had similar response rates following SARS-CoV-2 immunization as adult KT recipients. Immunologic response improved following a third immunization. Choice of antimetabolite and prednisolone dosing influenced the rate of response. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary Information Supplementary Information The online version contains supplementary material available at 10.1007/s00467-022-05679-y.

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Section: Discussionsupporting

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Immunologic response to SARS-CoV-2 mRNA vaccination in pediatric kidney transplant recipients

et al. 2022

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“…Table S3 shows the baseline characteristics of the studies 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , …”

Section: Resultsunclassified

Humoral and cellular response of COVID‐19 vaccine among solid organ transplant recipients: A systematic review and meta‐analysis

Meshram

Kute

Rane

et al. 2022

Transplant Infectious Dis

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Background We aimed to analyze the humoral and cellular response to standard and booster (additional doses) COVID‐19 vaccination in solid organ transplantation (SOT) and the risk factors involved for an impaired response. Methods We did a systematic review and meta‐analysis of studies published up until January 11, 2022, that reported immunogenicity of COVID‐19 vaccine among SOT. The study is registered with PROSPERO, number CRD42022300547. Results Of the 1527 studies, 112 studies, which involved 15391 SOT and 2844 healthy controls, were included. SOT showed a low humoral response (effect size [ES]: 0.44 [0.40–0.48]) in overall and in control studies (log‐Odds‐ratio [OR]: −4.46 [−8.10 to −2.35]). The humoral response was highest in liver (ES: 0.67 [0.61–0.74]) followed by heart (ES: 0.45 [0.32–0.59]), kidney (ES: 0.40 [0.36–0.45]), kidney‐pancreas (ES: 0.33 [0.13–0.53]), and lung (0.27 [0.17–0.37]). The meta‐analysis for standard and booster dose (ES: 0.43 [0.39–0.47] vs. 0.51 [0.43–0.54]) showed a marginal increase of 18% efficacy. SOT with prior infection had higher response (ES: 0.94 [0.92–0.96] vs. ES: 0.40 [0.39–0.41]; p ‐value < .01). The seroresponse with mRNA‐12723 mRNA was highest 0.52 (0.40–0.64). Mycophenolic acid (OR: 1.42 [1.21–1.63]) and Belatacept (OR: 1.89 [1.3–2.49]) had highest risk for nonresponse. SOT had a parallelly decreased cellular response (ES: 0.42 [0.32–0.52]) in overall and control studies (OR: −3.12 [−0.4.12 to −2.13]). Interpretation Overall, SOT develops a suboptimal response compared to the general population. Immunosuppression including mycophenolic acid, belatacept, and tacrolimus is associated with decreased response. Booster doses increase the immune response, but further upgradation in vaccination strategy for SOT is required.

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“…Otros autores han encontrado hallazgos similares con tasas de respuesta a dos dosis en trasplantados entre 22 % y 57 % [45,46], siendo más alto al emplear vacunas de ARNm, especialmente ARNm-1273 (47). Correia et al [48] encontraron que los pacientes que recibieron vacunas de ARNm tuvieron tasas significativamente más altas de seroconversión, en comparación con las vacunas de vector de adenovirus (67 % frente a 33 %, P < 0,001). También se ha encontrado que los niveles de protección humoral disminuyen rápidamente también en los trasplantados renales que inicialmente respondieron a la vacunación, independientemente del tipo de inmunoglobulina y del ensayo utilizado.…”

Section: Respuesta Inmunológica (Incluyendo La Respuesta Inmunológica...unclassified

Consenso colombiano sobre vacunación en pacientes con enfermedad renal crónica

Silva

Roncancio-Villamil

Forero-Delgadillo

et al. 2022

Rev. Colomb. Nefrol.

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Introducción: los pacientes con enfermedad renal son una población de alta complejidad por sus condiciones de multimorbilidad, riesgo cardiovascular y requerimiento de terapias inmunosupresoras. La vacunación es una de las principales estrategias para mitigar el riesgo de infecciones, no obstante, la respuesta a las vacunas se ve afectada por la pérdida de la calidad de la función inmunológica, efecto que es mayor en la medida en que la enfermedad renal progresa o se requiere el uso de medicamentos inmunosupresores. Por ello, las prácticas de inmunización deben ser incentivadas en los pacientes en estadios más precoces de su enfermedad. Desafortunadamente, existe un amplio desconocimiento por parte de los prestadores de atención respecto de las mejores prácticas de inmunización, adicionalmente, en Colombia no existe cobertura de aseguramiento en el plan de beneficios de salud para muchos de los biológicos requeridos. Objetivo: generar recomendaciones informadas en evidencia sobre vacunación en pacientes con enfermedad renal y condiciones especiales relacionadas. Metodología: a partir de una revisión y un análisis crítico de evidencia, el grupo desarrollador formuló recomendaciones sobre indicaciones, contraindicaciones y consideraciones especiales de inmunización en pacientes con enfermedad renal. Se consultó a un colectivo de expertos en infectología y nefrología sobre el acuerdo con las recomendaciones propuestas. Se definió un umbral de acuerdo del 80?%. Resultados: inicialmente se formularon 135 recomendaciones, de las cuales 124 recomendaciones fueron aprobadas en la consulta virtual, aquellas que no superaron el umbral fueron consensuadas en una sesión virtual. Al final del proceso se obtuvieron 142 recomendaciones. Conclusiones: la vacunación es una estrategia de prevención altamente recomendable en pacientes con enfermedad renal, con impactos favorables sobre la carga de enfermedad y la supervivencia. Se espera que las recomendaciones propuestas permitan orientar y estandarizar las prácticas de inmunización en estos pacientes y mejorar los desenlaces en salud para esta población.

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The type of SARS‐CoV‐2 vaccine influences serological response in kidney transplant recipients

Cited by 15 publications

References 15 publications

Immunologic response to SARS-CoV-2 mRNA vaccination in pediatric kidney transplant recipients

Immunologic response to SARS-CoV-2 mRNA vaccination in pediatric kidney transplant recipients

Humoral and cellular response of COVID‐19 vaccine among solid organ transplant recipients: A systematic review and meta‐analysis

Consenso colombiano sobre vacunación en pacientes con enfermedad renal crónica

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