Heterologous Immune Responses to Influenza Vaccine in Kidney Transplant Recipients

Background: Kidney failure patients on dialysis or after renal transplantation have a high risk for severe COVID-19 infection and vaccination against SARS-CoV-2 is the only expedient prophylaxis. Generally, immune responses are attenuated in kidney failure patients, however, systematic analyses of immune responses to SARS-CoV-2 vaccination in dialysis patients and in kidney transplant recipients (KTR) are still missing. Methods: In this prospective multicentric cohort study, antibody responses COVID-19 mRNA vaccines (BNT162b2; Biontech/Pfizer or mRNA-1273; Moderna) were measured in 32 dialysis patients and in 28 KTRs. SARS-CoV-2-specific antibodies and neutralization capacity were evaluated and compared to controls (n=78) in a similar age-range. Results: After the first vaccination, SARS-CoV-2-specific antibodies were nearly undetectable in kidney failure patients. After the second vaccination, 93% of the controls and 88% of dialysis patients but only 37% of KTRs developed SARS-CoV-2-specific IgG above cut-off. Moreover, mean IgG levels were significantly lower in KTRs (54±93 BAU/ml) compared to dialysis patients (503±481 BAU/ml, p<0.01). Both KTRs as well as dialysis patients had significantly lower IgG levels compared to controls (1992±2485 BAU/ml; p<0.001 and p<0.01). Importantly, compared to controls, neutralizing antibody titers were significantly lower in KTRs and dialysis patients. After the second vaccination, 76% of KTRs did not show any neutralization capacity against SARS-CoV-2 suggesting impaired seroprotection. Conclusions: Kidney failure patients show a significantly weaker antibody response compared to controls. Most strikingly, only one out four KTRs developed neutralizing antibodies against SARS-CoV-2 after two doses of vaccine. These data suggest that vaccination strategies need modification in immune transplant and dialysis patients.

Download Full-text

Influenza Vaccination in Kidney Transplant Recipients: Cellular and Humoral Immune Responses

Annals of Internal Medicine ◽

10.7326/0003-4819-92-4-471 ◽

1980 ◽

Vol 92 (4) ◽

pp. 471 ◽

Cited By ~ 40

Author(s):

WILLIAM A. BRIGGS

Keyword(s):

Immune Responses ◽

Influenza Vaccination ◽

Kidney Transplant ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Humoral Immune ◽

Humoral Immune Responses

Download Full-text

Faculty Opinions recommendation of Randomized controlled trial of adjuvanted versus nonadjuvanted influenza vaccine in kidney transplant recipients.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725765475.793545909 ◽

2018 ◽

Author(s):

Olivier Lortholary

Keyword(s):

Randomized Controlled Trial ◽

Influenza Vaccine ◽

Kidney Transplant ◽

Controlled Trial ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Randomized Controlled

Download Full-text

638. CMV-Specific T-Cell Immune Responses in Older vs. Younger Kidney Transplant Recipients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.645 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S232-S232

Author(s):

Emily Liang ◽

Maura Rossetti ◽

Gemalene Sunga ◽

Elaine Reed ◽

Joanna Schaenman

Keyword(s):

T Cell ◽

Immune Responses ◽

Kidney Transplant ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

T Cell Immune Responses

Download Full-text

Randomized Controlled Trial of Adjuvanted Versus Nonadjuvanted Influenza Vaccine in Kidney Transplant Recipients

Transplantation Journal ◽

10.1097/tp.0000000000000861 ◽

2016 ◽

Vol 100 (3) ◽

pp. 662-669 ◽

Cited By ~ 35

Author(s):

Deepali Kumar ◽

Patricia Campbell ◽

Katja Hoschler ◽

Luis Hidalgo ◽

Mona Al-Dabbagh ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Influenza Vaccine ◽

Kidney Transplant ◽

Controlled Trial ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Randomized Controlled

Download Full-text

Dissociation of humoral and cellular immune responses in kidney transplant recipients with EBV mucocutaneous ulcer

Transplant Infectious Disease ◽

10.1111/tid.13552 ◽

2021 ◽

Author(s):

Pierre Isnard ◽

Julie Bruneau ◽

Rebecca Sberro‐Soussan ◽

Dominique Wendum ◽

Christophe Legendre ◽

...

Keyword(s):

Immune Responses ◽

Kidney Transplant ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Cellular Immune Responses ◽

Cellular Immune

Download Full-text

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

Pathogens ◽

10.3390/pathogens11010067 ◽

2022 ◽

Vol 11 (1) ◽

pp. 67

Author(s):

Simone Cosima Boedecker-Lips ◽

Anja Lautem ◽

Stefan Runkel ◽

Pascal Klimpke ◽

Daniel Kraus ◽

...

Keyword(s):

Immune Responses ◽

Kidney Transplant ◽

Cell Response ◽

Cellular Response ◽

Chronically Ill ◽

Response Rates ◽

Hemodialysis Patients ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Antibody Titers

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.

Download Full-text