Immune Responses to SARS-CoV-2 Infection and Vaccination in Dialysis Patients and Kidney Transplant Recipients.

Patrick Affeldt,Steffen Hinrichs,Vivien Adam,Linus Butt,Christine Kurschat,Eva Heger,Matthias Meyer-Delpho,Franziska Grundmann,Veronica Di Cristanziano,Karl August Brensing,Aileen Ziegelhöfer,Claudia Schöler,Florian Klein,Wibke Johannis,Nils Kalisch,Julia Burian,Gertrud Steger,Eva Platen,Simon Oehm,Martin Gies,Thomas Benzing,Felix C Koehler ,Roman‐Ulrich Müller ,Dirk L Stippel

doi:10.3390/microorganisms10010004

Abstract

Dialysis patients and kidney transplant (KTX) recipients suffer from an impaired immune system and show a decreased response to the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) vaccination. We performed a retrospective analysis of 1505 serological SARS-CoV-2 measurements obtained from 887 dialysis patients and 86 KTX recipients. The results were separated by patient subgroups (dialysis/KTX) as well as SARS-CoV-2 status. The latter criterion included SARS-CoV-2-naïve patients with or without COVID-19 vaccination and convalescent patients receiving a booster shot. Serologies of 27 vaccinated healthy individuals served as the reference group. Vaccine-induced cellular immune response was quantified by an interferon-γ release assay in 32 KTX recipients. We determined seroconversion rates of 92.6%, 93.4%, and 71.4% in dialysis patients vaccinated with either BNT162b2, mRNA-1273, or AZD1222, respectively. Vaccination-induced anti-SARS-CoV-2 antibody titers were lower in dialysis patients compared to healthy individuals, and vaccination with mRNA-1273 induced higher titers than BNT162b2. The initial seroconversion rate was 39.5% in KTX recipients vaccinated with BNT162b2. A linear regression model identified medication with mycophenolate-mofetil/mycophenolic acid as an independent risk factor for missing seroconversion. Within a cohort of 32 KTX recipients, cellular and humoral immune reactivity to SARS-CoV-2 was detectable in three patients only. Conclusively, vaccine-induced seroconversion rates were similar in dialysis patients compared to healthy individuals but were strongly impaired in KTX recipients. Anti-SARS-CoV-2 IgG titers elicited by double active immunization were significantly lower in both cohorts compared to healthy individuals, and immune responses to vaccination vanished quickly.

Highlights

Hemodialysis (HD) patients and kidney transplant (KTX) recipients are at risk for severe coronavirus disease-19 (COVID-19) [1,2]
In order to monitor SARS-CoV-2 infections, a cohort of 206 SARS-CoV-2-naïve dialysis patients was screened for anti-SARS-CoV-2 NC antibodies one year after the beginning of the pandemic, using a pan-Ig assay
40 days after initial SARS-CoV-2 diagnosis by real-time PCR, antibodies were identified in 71.4% (5/7) of the dialysis patients that recovered from COVID-19

Summary

Introduction

Hemodialysis (HD) patients and kidney transplant (KTX) recipients are at risk for severe coronavirus disease-19 (COVID-19) [1,2]. Active immunization against SARS-CoV-2, in particular with messenger ribonucleic acid (mRNA) vaccines, is considered the most effective preventive strategy to protect vulnerable individuals from infection and severe COVID-19 courses [9]. Both the intensity and duration of the immune response after vaccination in specific patient groups has not been fully characterized. The increasing available data from different studies on the efficacy of SARS-CoV-2 vaccination in solid organ transplant (SOT) recipients revealed a strongly impaired humoral and cellular immune response compared to the general population, with a reported seroconversion of below 45% and an impaired cellular response [16,17,18,19]

Methods

Results

Conclusion