The Effect of a Booster Dose mRNA Vaccine on COVID-19 Infection in Kidney Transplant Recipients after Inactivated or Viral Vector Vaccine Immunization

Abstract

The mortality rate after novel coronavirus infection, which causes severe acute respiratory distress syndrome (SARS-CoV-2), is much higher in kidney transplant recipients (KTRs) compared to the general population. Seroconversion after vaccination is also lower, and breakthrough infection is much higher. Many studies reported seroconversion rate after a booster (third) dose of vaccine but clinical outcomes received less attention. Here, we reported the impact of an mRNA vaccine booster dose on clinical outcomes of KTRs with SARS-CoV-2 infection. A total of 183 KTRs with SARS-CoV-2 infection were identified. Of 183 KTRs, 146 KTRs had sufficient data for analysis and were included in this study. Forty-eight patients (32.9%) received zero to 1 doses of vaccine (Group 1), thirty-one (21.2%) received two doses (Group 2), and sixty-seven (45.9%) received a booster dose (Group 3). Pneumonia developed in 50%, 23%, and 10% in Group 1, 2, and 3 (p < 0.001). Hospital admission requirement was 81%, 48%, and 12% (p < 0.001). Mortality rate was 26%, 3%, and 3% (p = 0.001). A multivariate analysis showed that only diabetes adversely affects mortality while the booster dose of the vaccine significantly reduced mortality. The booster dose of the vaccine is strongly recommended in all KTRs especially those with diabetes. Our study also suggested the timing of the booster dose vaccine to be administered within 4 months after the second dose.

SARS-CoV-2-Specific Antibodies, B Cell and T Cell Immune Responses after ChAdOx1 nCoV-19 Vaccination in Solid Organ Transplant Recipients

“…Meanwhile, combining multiple immunosuppressive drugs still causes a significant risk for various infections because of dramatically reduced immunity against viruses, bacteria, and other pathogens [2][3][4][5]. Therefore, SOT recipients are vulnerable to severe COVID-19 due to an immunosuppressive state [6].…”

“…Immunization against SARS-CoV-2 is essential and proven to avoid complications and unfavorable consequences [6,7]. However, suboptimal immunogenicity, especially humoral immunity (HMI), is concerning among these specific individuals [8,9].…”

The immunologic outcomes and adverse events of COVID-19 vaccine booster dose in immunosuppressed people: A systematic review

“…Although the disease has affected all groups of people, those with chronic comorbidities are among the most vulnerable individuals ( Guven et al, 2023 , Mehraeen et al, 2022 ). Certain populations ( Balsby et al, 2022 ) including solid organ transplant recipients (SOTR) such as those who have undergone kidney ( Affeldt et al, 2022 , Brandstetter et al, 2022 , Hod et al, 2022 , Schrezenmeier et al, 2022 , Thotsiri et al, 2022 ), liver ( Davidov et al, 2022 , Sriphoosanaphan et al, 2022 ), lung ( Catry et al, 2022 ) and heart transplants ( Peled et al, 2022 ) as well as patients with conditions like immune-mediated inflammatory diseases and multiple sclerosis who receive immunosuppressive treatments ( Bjørlykke et al, 2023 , Smetanova et al, 2022 , Wroński et al, 2022 ), face greater disease severity. Furthermore, patients diagnosed with various malignancies ( Benitez Fuentes et al, 2022 , Diamantopoulos et al, 2022 , Goldwater et al, 2023 , Ollila et al, 2022 , Storti et al, 2022 , Tanzilli et al, 2022 , Terpos et al, 2022 ) or immune deficiencies ( Fidler et al, 2023 , Gianserra et al, 2022 , Kling et al, 2023 ) experience a more severe course of illness due to a combination of their immunosuppressive medications and the nature of their underlying condition.…”

“…Immunity to SARS-CoV-2 in individuals and populations arises from either prior infection or vaccination, mediated by humoral and cellular immune responses ( Thotsiri et al, 2022 , Hod et al, 2023 ). The effectiveness of COVID-19 vaccines in preventing SARS-CoV-2 infection and diminishing the severity of the disease has been established ( Lin et al, 2022 , Dadras et al, 2022 ).…”

Intensive Care during the COVID-19 Pandemic

“…Therefore, in response to the current pandemic, and in addition to non-pharmaceutical interventions (NPIs), such as social distancing, increased hand hygiene, and the wearing of surgical masks, vaccination is expected to be a safe and effective way to help build the immune barrier [ 10 , 14 , 15 , 16 , 17 , 18 , 19 ]. To date, there are more than 200 COVID-19 vaccine candidates in various stages of development, and more than 50 vaccine candidates have entered clinical trials, including the use of nucleic acids (DNA or RNA), inactivated or live attenuated viruses, viral vectors, and recombinant proteins or virus particles [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. However, there is a time lag between vaccine development and distribution in clinics.…”