Abstract
BackgroundThe humoral and cellular immune responses to SARS-COV-2 vaccination remain to be elucidated in hemodialysis (HD) patients and kidney transplant recipients (KTRs), considering their baseline immunosuppressed status. The aim of our study was to assess the associations of vaccine-induced antibody responses with circulating lymphocytes sub-populations and their respective patterns of alterations in maintenance HD patients and KTRs.Materials and MethodsWe included 34 HD patients and 54 KTRs who received two doses of the mRNA-vaccine BNT162b2. Lymphocyte subpopulations were analyzed by flow cytometry before vaccination (T0), before the second vaccine dose (T1) and 2 weeks after the second dose (T2). The anti-SARS-CoV2 antibody response was assessed at T1 and at T2.Results31 HD patients (91.8%) and 16 KTRs (29.6%) became seropositive at T2. HD patients who became seropositive following the first dose displayed higher CD19+ B lymphocytes compared to their seronegative HD counterparts. A positive correlation was established between CD19+ B cells counts and antibody titers at all time-points in both groups (p < 0.001). KTRs showed higher naïve CD4+CD45RA+ T helper cells compared to HD patients at baseline and T2 whereas HD patients displayed higher memory CD45RO+ T cells compared to KTRs at T2. The naïve CD4+CD45RA to memory CD4+CD45RO+ T helper cells fraction was negatively associated with antibody production in both groups.ConclusionsOur study provides a potential conceptual framework for monitoring vaccination efficacy in HD patients and KTRs considering the correlation established between CD19+ B cells, generation of memory CD4+ T helper cells and anti SARS-CoV2 antibody response to vaccination.
Highlights
The COVID-19 pandemic poses unique challenges to patients undergoing maintenance renal replacement therapy and kidney transplant recipients (KTRs) with available evidence until now indicating a higher morbidity and mortality trend following infection compared with the general population [1, 2]
The findings of our study suggest that evaluation of both CD19+ lymphocytes and CD4+CD45RO helper T cell subsets in the peripheral circulation might serve as a means for estimation of the subsequent immune responses to vaccination in these patients
Our findings regarding the induction of CD4+CD45RO memory T helper cells in HD patients and KTRs following vaccination is an indicator, albeit indirect, which allows us to speculate that administration of the BNT162b2 vaccine elicits a cellular immune memory response in addition antibody production
Summary
The COVID-19 pandemic poses unique challenges to patients undergoing maintenance renal replacement therapy and kidney transplant recipients (KTRs) with available evidence until now indicating a higher morbidity and mortality trend following infection compared with the general population [1, 2]. The complex derangement of the immune system as occurs both in end-stage kidney disease (ESKD) and kidney transplantation has been directly associated with an increased susceptibility to infections and impaired response to vaccination in these patients [3, 4]. Overall, decreased numbers of circulating T, B and NK lymphocytes as well as altered CD4+ and CD8+ T cell responses and low antibody production by B lymphocytes following stimulation have been found in hemodialysis patients [5, 6]. The humoral and cellular immune responses to SARS-COV-2 vaccination remain to be elucidated in hemodialysis (HD) patients and kidney transplant recipients (KTRs), considering their baseline immunosuppressed status.
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