#6041 THE IMMUNE EFFECTS OF SARS-COV-2 INFECTION AND BNT162B2 VACCINATION IN CKD PATIENTS AND TRANSPLANT RECIPIENTS

Abstract

Abstract Background and Aims The use of vaccination against severe acute respiratory syndrome coronavirus (SARS-CoV-2) significantly limited the spread of the coronavirus disease 2019 (COVID-19) pandemic. However, it was reported that after 6 months of vaccination (including the BNT162b2 vaccine) immunity decreases in general population. The results for chronic kidney disease (CKD) patients and solid-organ transplant (SOT) recipients appeared similar. Therefore, it was proposed to use an immune booster with the next, third or fourth vaccination dose to prolong immunity. We aimed to find the most effective immunization schedules in CKD patients in comparison to kidney (KTRs) and liver transplant recipients (LTRs). Method We retrospectively analyzed the data of randomly selected 40 patients with IgA nephropathy (IgAN) as representatives of the CKD group and 78 SOT recipients (37 KTRs and 41 LTRs). They received two or three 30 μg doses of BNT162b2 vaccine. The follow up was performed in five time points (TP1-5): 4-6 weeks after the 1st dose (TP1), 4-8 weeks after 2nd dose (TP2), 9-20 weeks after 2nd dose (TP3), 21-32 weeks after 2nd dose and 1-12 weeks after 3rd dose (TP4), 33-48 weeks after 2nd dose, at the same time 4-20 weeks after 3rd dose (TP5). We assessed the anti-SARS-CoV-2 spike 1 protein IgG antibody (anti-S1 Ab) titer as well as graft function, COVID-19 history and patients’ clinical condition. Results We found Ab titer in IgAN group higher than in SOT patients (p = 0.05). LTRs achieved higher values than KTRs. 55 patients received 3 doses of vaccination. The protective level after the 3rd dose was not observed only in 8.4% at TP4 and 5% at TP5. We demonstrated the advantage in Ab levels of a 2 doses vaccination scheme with and without COVID-19 history over a 3 doses in a group of patients with no COVID-19 history in TP 1-4 (p = <0,001 - 0,005, respectively, Table1). Subjects in 2 doses schedule had a longer time to infection from the last dose compared to the 3 doses schedule (31.5-39 vs. 9 weeks, MD). No deterioration of renal or graft function was noted and no rejection episodes were diagnosed. Conclusion Immunocompromised patients are non-homogeneous with respect to the vaccine response immunity. Therefore, the approach to the vaccination schedule should be individualized based on measurements of vaccination response and medical history including COVID-19 history. Combined post-infectious and post-vaccination immunization appears to be the most effective in producing anti-SARS-CoV-2 responses.