Seroconversion rate after primary vaccination with two doses of BNT162b2 versus mRNA-1273 in solid organ transplant recipients: a systematic review and meta-analysis

Verleye, Arno; Wijtvliet, Veerle; Abrams, Steven A.; Hellemans, Rachel; Bougrea, Rania; Massart, Annick; Pipeleers, Lissa; Wissing, Karl Martin; Ariën, Kevin K.; Winter, Benedicte Y. De; Damme, Pierre Van; Abramowicz, Daniel; Ledeganck, Kristien J.

doi:10.1093/ndt/gfac174

Cited by 13 publications

(7 citation statements)

References 33 publications

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“…Previous studies have shown a response rate to a mRNA vaccine of 48% [9] , 47.5% [10] , [11] and 44.9% [12] in patients with SOT, response rates significantly lower than that we observed in our OLT cohort (>80% RBD response rate). In the case of mRNA-1273 vaccine, a serological response of 93% [13] was seen vs. 100% in our study, and it is even higher than the liver subset analyzed in a recent SOT meta -analysis [12] , [14] . In the case of CoronaVac, in Uruguay [15] , a higher seroconversion rate, as compared with our cohort (36.5% vs. 13%) was observed.…”

Section: Discussioncontrasting

confidence: 63%

Humoral response to different SARS-CoV-2 vaccines in orthotopic liver transplant recipients

Toapanta‐Yanchapaxi

Chiquete

Ávila-Rojo

et al. 2022

Vaccine

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Section: Discussioncontrasting

confidence: 63%

Humoral response to different SARS-CoV-2 vaccines in orthotopic liver transplant recipients

Toapanta‐Yanchapaxi

Chiquete

Ávila-Rojo

et al. 2022

Vaccine

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“…Conditions associated with a favourable response at 6 months included initial vaccination with the mRNA 1273 vaccine, a positive humoral response at month 3, having received a third dose, and not being a KTR. The ability of the mRNA 1273 vaccine to induce stronger seroconversion than BNT162b2 was confirmed by other studies in HD patients [ 18 , 25 ] and in a meta-analysis of solid organ transplant patients (8 studies, 877 and 956 patients vaccinated with mRNA 1273 and BNT162b2, respectively) [ 26 ].…”

Section: Humoral Immunity After Sars-cov-2 Vaccinationsupporting

confidence: 53%

What has vaccination against COVID-19 in CKD patients taught us?

2023

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Effective vaccination strategies are of crucial importance to protecting patients who are vulnerable to infections, such as patients with chronic kidney disease. This is because the decreased efficiency of the immune system in chronic kidney disease impairs vaccine-induced immunisation. COVID-19 has prompted investigation of the immune response to SARS-CoV-2 vaccines in chronic kidney disease and in kidney transplant recipients in an effort to improve efficacy. The seroconversion rate after two vaccine doses is reduced, especially in kidney transplant recipients. Furthermore, although the seroconversion rate in chronic kidney disease patients is as high as in healthy subjects, anti-spike antibody titres are lower than in healthy vaccinated individuals, and these titres decrease rapidly. Although the vaccine-induced anti-spike antibody titre correlates with neutralising antibody levels and with protection against COVID-19, the protective prognostic significance of their titre is decreased due to the emergence of SARS-CoV-2 variants other than the Wuhan index virus against which the original vaccines were produced. Cellular immunity is also relevant, and because of cross-reactivity to the spike protein, epitopes of different viral variants confer protection against newly emerging variants of SARS-CoV-2. A multi-dose vaccination strategy is the most effective way to obtain a sufficient serological response. In kidney transplant recipients, a 5-week discontinuation period from antimetabolite drugs in concomitance with vaccine administration may also increase the vaccine’s efficacy. The newly acquired knowledge obtained from COVID-19 vaccination is of general interest for the success of other vaccinations in chronic kidney disease patients.

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“…Nonseroconversion rates after 2 vaccinations were relatively low compared with other studies using mRNA-based SARS-CoV-2 vaccines, which could be due to the cohorts consisting of long-term KTRs (median time after transplantation is 7.6 and 6.9 y) with 60% to 70% of them using MMF/MPA. Also, all fully vaccinated KTRs received the mRNA-1273 vaccine, which has higher seroconversion rates and clinical effectiveness than BNT162b2 in KTRs with breakthrough infections, 50 , 51 which aids in the discussion of whether mRNA-1273 should be the preferred vaccine in these patients. Although the type of third vaccine did not influence the prediction of nonseroconversion, we see an improved discrimination in the much smaller mRNA-1273 cohort, the type of vaccine on which the model was originally built.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Nonseroconversion to SARS-CoV-2 Vaccination in Kidney Transplant Recipients

Frölke¹,

Bouwmans²,

Messchendorp³

et al. 2022

Transplantation Direct

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Background. Kidney transplant recipients (KTRs) are still at risk of severe COVID-19 disease after SARS‑CoV‑2 vaccination, especially when they have limited antibody formation. Our aim was to understand the factors that may limit their humoral response. Methods. Our data are derived from KTRs who were enrolled in the Dutch Renal Patients COVID-19 Vaccination consortium, using a discovery cohort and 2 external validation cohorts. Included in the discovery (N = 1804) and first validation (N = 288) cohorts were participants who received 2 doses of the mRNA-1273 vaccine. The second validation cohort consisted of KTRs who subsequently received a third dose of any SARS-CoV-2 vaccine (N = 1401). All participants had no history of SARS-CoV-2 infection. A multivariable logistic prediction model was built using stepwise backward regression analysis with nonseroconversion as the outcome. Results. The discovery cohort comprised 836 (46.3%) KTRs, the first validation cohort 124 (43.1%) KTRs, and the second validation cohort 358 (25.6%) KTRs who did not seroconvert. In the final multivariable model‚ 12 factors remained predictive for nonseroconversion: use of mycophenolate mofetil/mycophenolic acid (MMF/MPA); chronic lung disease, heart failure, and diabetes; increased age; shorter time after transplantation; lower body mass index; lower kidney function; no alcohol consumption; ≥2 transplantations; and no use of mammalian target of rapamycin inhibitors or calcineurin inhibitors. The area under the curve was 0.77 (95% confidence interval [CI], 0.74-0.79) in the discovery cohort after adjustment for optimism, 0.81 (95% CI, 0.76-0.86) in the first validation cohort, and 0.67 (95% CI, 0.64-0.71) in the second validation cohort. The strongest predictor was the use of MMF/MPA, with a dose-dependent unfavorable effect, which remained after 3 vaccinations. Conclusions. In a large sample of KTRs, we identify a selection of KTRs at high risk of nonseroconversion after SARS-CoV-2 vaccination. Modulation of MMF/MPA treatment before vaccination may help to optimize vaccine response in these KTRs. This model contributes to future considerations on alternative vaccination strategies.

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Seroconversion rate after primary vaccination with two doses of BNT162b2 versus mRNA-1273 in solid organ transplant recipients: a systematic review and meta-analysis

Cited by 13 publications

References 33 publications

Humoral response to different SARS-CoV-2 vaccines in orthotopic liver transplant recipients

Humoral response to different SARS-CoV-2 vaccines in orthotopic liver transplant recipients

What has vaccination against COVID-19 in CKD patients taught us?

Predictors of Nonseroconversion to SARS-CoV-2 Vaccination in Kidney Transplant Recipients

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