Evaluating the antibody response to SARS-COV-2 vaccination amongst kidney transplant recipients at a single nephrology centre

Abstract

Background and objectives Kidney transplant recipients are highly vulnerable to the serious complications of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infections and thus stand to benefit from vaccination. Therefore, it is necessary to establish the effectiveness of available vaccines as this group of patients was not represented in the randomized trials. Design, setting, participants, & measurements A total of 707 consecutive adult kidney transplant recipients in a single center in the United Kingdom were evaluated. 373 were confirmed to have received two doses of either the BNT162b2 (Pfizer-BioNTech) or AZD1222 (Oxford-AstraZeneca) and subsequently had SARS-COV-2 antibody testing were included in the final analysis. Participants were excluded from the analysis if they had a previous history of SARS-COV-2 infection or were seropositive for SARS-COV-2 antibody pre-vaccination. Multivariate and propensity score analyses were performed to identify the predictors of antibody response to SARS-COV-2 vaccines. The primary outcome was seroconversion rates following two vaccine doses. Results Antibody responders were 56.8% (212/373) and non-responders 43.2% (161/373). Antibody response was associated with greater estimated glomerular filtration (eGFR) rate [odds ratio (OR), for every 10 ml/min/1.73m2 = 1.40 (1.19–1.66), P<0.001] whereas, non-response was associated with mycophenolic acid immunosuppression [OR, 0.02(0.01–0.11), p<0.001] and increasing age [OR per 10year increase, 0.61(0.48–0.78), p<0.001]. In the propensity-score analysis of four treatment variables (vaccine type, mycophenolic acid, corticosteroid, and triple immunosuppression), only mycophenolic acid was significantly associated with vaccine response [adjusted OR by PSA 0.17 (0.07–0.41): p<0.001]. 22 SARS-COV-2 infections were recorded in our cohort following vaccination. 17(77%) infections, with 3 deaths, occurred in the non-responder group. No death occurred in the responder group. Conclusion Vaccine response in allograft recipients after two doses of SARS-COV-2 vaccine is poor compared to the general population. Maintenance with mycophenolic acid appears to have the strongest negative impact on vaccine response.

Head-to-Head Comparison of 5 Anti-SARS-CoV-2 Assays Performance in One Hundred COVID-19 Vaccinees, over an 8-Month Course

“…Then, after the general implementation of vaccinations, anti-SARS-CoV-2 assays started to be used to assess individual humoral responses to inoculation [ 5 ]. This is particularly important in certain groups of patients, such as the elderly or immunosuppressed [ 6 , 7 ].…”

Interpretation of non-responders to SARS-CoV-2 vaccines using WHO International Standard

“…There were 22 breakthrough infections and 3 deaths after vaccination, including 77% (17/22) infections and 13.6% (3/22) deaths in the seronegative group and only 23% (5/22) infections and 0% (0/22) deaths in the seropositive group. 38 However, this study did not use the WHO IS to get a cutoff for the responder. Therefore, there may be some non-responders (fold-index <4) in the seropositive group according to our study.…”

Immunological findings in a group of individuals who were non-responders to standard two-dose SARS-CoV-2 vaccines

“…There were 22 breakthrough infections and 3 deaths after vaccination, including 77% (17/22) infections and 13.6% (3/22) deaths in the seronegative group and only 23% (5/22) infections and 0% (0/22) deaths in the seropositive group. 18 Chavarot et al reported that administration of a third dose of BNT162b2 vaccine did not improve immunogenicity in KTRs treated with belatacept without prior COVID-19. Seropositivity was only 37.1% (13/35) of KTRs after the third vaccine dose.…”

“…Chukwu et al reported clinical findings in a group of kidney transplant recipients received two doses of the SARS-CoV-2 vaccine. 18 There were 22 breakthrough infections and 3 deaths after vaccination, including 77% (17/22) infections and 13.6% (3/22) deaths in the non-responder group and only 23% (5/22) infections and 0% (0/22) deaths in the responder group. 18 Therefore, there is an urgent need to identify SARS-CoV-2 vaccine non-responders in the vulnerable population to reduce severe COVID-19 and mortality.…”