Six-Month Follow-Up after Vaccination with BNT162b2: SARS-CoV-2 Antigen-Specific Cellular and Humoral Immune Responses in Hemodialysis Patients and Kidney Transplant Recipients

Abstract

Hemodialysis patients (HDP) and kidney transplant recipients (KTR) have a high risk of infection with SARS-CoV-2 with poor clinical outcomes. Because of this, vaccination of these groups of patients against SARS-CoV-2 is particularly important. However, immune responses may be impaired in immunosuppressed and chronically ill patients. Here, our aim was to compare the efficacy of an mRNA-based vaccine in HDP, KTR, and healthy subjects. Design: In this prospective observational cohort study, the humoral and cellular response of prevalent 192 HDP, 50 KTR, and 28 healthy controls (HC) was assessed 1, 2, and 6 months after the first immunization with the BNT162b2 mRNA vaccine. Results: After 6 months, 97.5% of HDP, 37.9% of KTR, and 100% of HC had an antibody response. Median antibody levels were 1539.7 (±3355.8), 178.5 (±369.5), and 2657.8 (±2965.8) AU/mL in HDP, KTR, and HC, respectively (p ≤ 0.05). A SARS-CoV-2 antigen-specific cell response to vaccination was found in 68.8% of HDP, 64.5% of KTR, and 90% of HC. Conclusion: The humoral response rates to mRNA-based vaccination of HDPs are comparable to HCs, but antibody titers are lower. Furthermore, HDPs have weaker T-cell response to vaccination than HCs. KTRs have very low humoral and antigen-specific cellular response rates and antibody titers, which requires other vaccination strategies in addition to booster vaccination.

Humoral and cellular immune responses to the mRNA-1273 SARS-CoV-2 vaccine booster in patients on maintenance dialysis

“…Our results indicate a robust humoral immune response 6 months following primary COVID-19 vaccine cycle (> 90%), which is consistent with previous reports involving hemodialysis patients and healthy controls [ 3 , 4 ]. However, while primary COVID-19 vaccine cycle resulted in markedly high anti-SARS-CoV-2 spike antibody levels (levels were highest in patients with previous COVID-19), the humoral response waned significantly within 6 months.…”

“…In contrast, we observed a sustained weak cellular immune response post-booster, although IFN-γ stimulation index levels increased significantly. Therefore, in line with previous works [ 4 ], antibody presence may not automatically correlate with functional cellular immunity, which is likely an important component in long-term protection against SARS-CoV-2. We and others have previously shown that cytokine induction during primary infection is associated with preferential induction of T cells producing IL-2, whereas reactivations are associated with T cells producing IFN [ 5 ].…”

SARS-CoV-2 spike protein antibody titers 6 months after SARS-CoV-2 mRNA vaccination among patients undergoing hemodialysis in Japan

“…With respect to long-term humoral immunity after vaccination, several studies among health care workers have reported that SARS-CoV-2 spike protein antibody titers and neutralizing antibodies progressively decline up to 6 months after vaccination [ 3 , 4 , 37 , 38 ]. Studies of HD patients in Germany showed that SARS-CoV-2 spike protein antibody titers peaked 1 month after the second vaccination in dialysis patients and declined to approximately 50% of peak values 3–4 months later [ 5 , 23 , 39 ]. The results of the present study showed that 6 months after the second dose of the BNT162b2 vaccine, SARS-CoV-2 spike protein antibody titers were markedly decreased (approximately one-seventh) compared with the peak value 1 month after vaccination.…”

“…The clinical history and dialysis prescription were obtained from the medical records. Information about use of vitamin D, serum albumin levels, hemoglobin levels, and Kt/V is also collected, since these items are reportedly associated with SARS-CoV-2 spike protein antibody titer after the vaccination in patients undergoing HD [ 22 , 23 , 26 , 27 ]. Data for the control group were unavailable in this study, except for anti-S1 IgG antibody titers, age, sex, height, body weight, and history of SARS-CoV-2 infection.…”

“…Neutralizing antibody titers and SARS-CoV-2 spike protein antibody titers are reported to be lower in HD patients compared with those in healthy controls 1 to 2 months after SARS-CoV-2 mRNA vaccination [ 16 – 18 ], and importantly, both antibody titers have strong correlation [ 19 – 21 ]. Although there are few reports of long-term observation of post-vaccination antibody titers in patients with ESKD, studies in Israel and Germany have reported that dialysis patients had lower antibody titer levels 6 months after vaccination compared with healthy individuals [ 22 , 23 ]. However, to our knowledge, there are no reports of antibody titers being examined up to 6 months after SARS-CoV-2 mRNA vaccination in patients receiving HD in Asia, including in Japan.…”