51
|
Haarhaus M, Duhanes M, Leševic N, Matei B, Ramsauer B, Da Silva Rodrigues R, Su J, Haase M, Santos‐ Araújo C, Macario F. Improved immunologic response to COVID-19 vaccine with prolonged dosing interval in haemodialysis patients. Scand J Immunol 2022; 95:e13152. [PMID: 35244289 PMCID: PMC9115353 DOI: 10.1111/sji.13152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/09/2022] [Accepted: 02/25/2022] [Indexed: 11/29/2022]
Abstract
Vaccination against 2019 coronavirus disease (COVID-19) can reduce disease incidence and severity. Dialysis patients demonstrate a delayed immunologic response to vaccines. We determined factors affecting the immunologic response to COVID-19 vaccines in haemodialysis patients. All patients within a Swedish haemodialysis network, vaccinated with two doses of COVID-19 vaccine 2-8 weeks before inclusion, were eligible for this cross-sectional study. Severe adult respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein antibody levels were determined by EliA SARS-CoV-2-Sp1 IgG test (Thermo Fisher Scientific, Phadia AB) and related to clinical and demographic parameters. Eighty-nine patients were included. Patients were vaccinated with two doses of Comirnaty (BNT162b2, 73%) or Spikevax (mRNA-1273, 23,6%). Three patients received combinations of different vaccines. Response rate (antibody titres >7 U/mL) was 89.9%, while 39.3% developed high antibody titres (>204 U/mL), 47 (43-50) days after the second dose. A previous COVID-19 infection associated with higher antibody titres (median (25th-75th percentile) 1558.5 (814.5-3,763.8) U/mL vs 87 (26-268) U/mL, P = .002), while time between vaccine doses did not differ between groups (P = .7). Increasing SARS-CoV-2 antibody titres were independently associated with increasing time between vaccine doses (B 0.241, P = .02), decreasing serum calcium levels (B -0.233, P = .007) and previous COVID-19 (B 1.078, P < .001). In conclusion, a longer interval between COVID-19 mRNA vaccine doses, lower calcium and a previous COVID-19 infection were independently associated with a stronger immunologic vaccination response in haemodialysis patients. While the response rate was good, only a minority developed high antibody titres, 47 (43-50) days after the second vaccine dose.
Collapse
Affiliation(s)
- Mathias Haarhaus
- Diaverum ABMalmöSweden
- Department of Clinical Sciences, Intervention and TechnologyDivision of Renal MedicineKarolinska InstitutetKarolinska University HospitalStockholmSweden
| | | | | | | | | | | | - Jun Su
- Karolinska University LaboratoryKarolinska University HospitalStockholmSweden
| | - Michael Haase
- Diaverum ABMalmöSweden
- Medical FacultyOtto‐von‐Guericke University MagdeburgMagdeburgGermany
| | - Carla Santos‐ Araújo
- Diaverum ABMalmöSweden
- Faculty of MedicineCardiovascular Research and Development UnitPortoPortugal
| | | |
Collapse
|
52
|
Alfano G, Fontana F, Ferrari A, Morisi N, Gregorini M, Cappelli G, Magistroni R, Guaraldi G, Donati G. Which criteria should we use to end isolation in hemodialysis patients with COVID-19? Clin Kidney J 2022; 15:1450-1454. [PMID: 36824062 PMCID: PMC9942439 DOI: 10.1093/ckj/sfac115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Indexed: 11/14/2022] Open
Abstract
Safe and timely discontinuation of quarantine of in-center hemodialysis (HD) patients with a previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is a challenging issue for the nephrological community because current guidelines for ending isolation do not mention dialysis patients. To prevent potentially fatal outbreaks of coronavirus disease 2019 (COVID-19), a cautionary approach has been adopted by most dialysis units. The criteria for ending the isolation in the HD population generally coincide with those recommended for immunocompromised people. Thus, a test-based strategy relying on two consecutive negative reverse transcriptase-polymerase chain reaction (RT-PCR) nasopharyngeal swabs has been adopted to terminate quarantine. This strategy has the disadvantage of prolonging isolation as RT-PCR positivity does not equate to SARS-CoV-2 infectivity. Consequentially, prolonged positivity of SARS-CoV-2 results in excessive workload for the HD staff who must face an increasing number of COVID-19 patients requiring isolation. This condition leads also to serious implications for the patients and their households including work productivity loss, postponement of health-care appointments and an increased risk of COVID-19 reinfection. To counteract this problem, other diagnostic tests should be used to provide the best care to HD patients. Recent results seem to encourage the use of RT-PCR cycle threshold (Ct) values and rapid antigen tests given their better correlation with cell culture for SARS-CoV-2 than RT-PCR testing. Here, we provide an overview of the current scientific evidence on the tests used to verify the infectiousness of the virus in order to stimulate the nephrological community to adopt a streamlined and pragmatic procedure to end isolation in COVID-19 patients on HD.
Collapse
Affiliation(s)
| | - Francesco Fontana
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Annachiara Ferrari
- Nephrology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Niccolò Morisi
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Italy
| | - Mariacristina Gregorini
- Nephrology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Gianni Cappelli
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Italy
| | - Riccardo Magistroni
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy,Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Italy
| | - Giovanni Guaraldi
- Clinic of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | - Gabriele Donati
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy,Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Italy
| |
Collapse
|
53
|
Füessl L, Lau T, Lean I, Hasmann S, Riedl B, Arend FM, Sorodoc-Otto J, Soreth-Rieke D, Toepfer M, Rau S, Salihi-Halimi H, Paal M, Beuthien W, Thaller N, Suttmann Y, von Gersdorff G, Regenauer R, von Bergwelt-Baildon A, Teupser D, Bruegel M, Fischereder M, Schönermarck U. Diminished Short- and Long-Term Antibody Response after SARS-CoV-2 Vaccination in Hemodialysis Patients. Vaccines (Basel) 2022; 10:vaccines10040605. [PMID: 35455353 PMCID: PMC9031197 DOI: 10.3390/vaccines10040605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/04/2022] [Accepted: 04/12/2022] [Indexed: 12/19/2022] Open
Abstract
Short-term studies have shown an attenuated immune response in hemodialysis patients after COVID-19-vaccination. The present study examines how antibody response is maintained after vaccination against SARS-CoV-2 in a large population of hemodialysis patients from six outpatient dialysis centers. We retrospectively assessed serum antibody levels against SARS-CoV-2 spike protein and nucleocapsid protein (electrochemiluminescence immunoassays, Roche Diagnostics) after COVID-19-vaccination in 298 hemodialysis and 103 non-dialysis patients (controls), comparing early and late antibody response. Compared to a non-dialysis cohort hemodialysis patients showed a favorable but profoundly lower early antibody response, which decreased substantially during follow-up measurement (median 6 months after vaccination). Significantly more hemodialysis patients had anti-SARS-CoV-2-S antibody titers below 100 U/mL (p < 0.001), which increased during follow-up from 23% to 45% but remained low in the control group (3% vs. 7%). In multivariate analysis, previous COVID-19 infections (p < 0.001) and female gender (p < 0.05) were significantly associated with higher early as well as late antibody vaccine response in hemodialysis patients, while there was a significant inverse correlation between patient age and systemic immunosuppression (p < 0.001). The early and late antibody responses were significantly higher in patients receiving vaccination after a SARS-CoV-2 infection compared to uninfected patients in both groups (p < 0.05). We also note that a higher titer after complete immunization positively affected late antibody response. The observation, that hemodialysis patients showed a significantly stronger decline of SARS-CoV-2 vaccination antibody titers within 6 months, compared to controls, supports the need for booster vaccinations to foster a stronger and more persistent antibody response.
Collapse
Affiliation(s)
- Louise Füessl
- Department of Medicine IV, University Hospital, LMU Munich, 81377 Munich, Germany; (L.F.); (I.L.); (S.H.); (R.R.); (A.v.B.-B.); (M.F.)
| | - Tobias Lau
- Dialysezentrum Bad Tölz und Wolfratshausen, 83646 Bad Tölz, Germany; (T.L.); (S.R.)
| | - Isaac Lean
- Department of Medicine IV, University Hospital, LMU Munich, 81377 Munich, Germany; (L.F.); (I.L.); (S.H.); (R.R.); (A.v.B.-B.); (M.F.)
| | - Sandra Hasmann
- Department of Medicine IV, University Hospital, LMU Munich, 81377 Munich, Germany; (L.F.); (I.L.); (S.H.); (R.R.); (A.v.B.-B.); (M.F.)
| | - Bernhard Riedl
- KfH-Nierenzentrum Bayreuth, 95445 Bayreuth, Germany; (B.R.); (H.S.-H.)
| | - Florian M. Arend
- Institute of Laboratory Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (F.M.A.); (M.P.); (D.T.); (M.B.)
| | - Johanna Sorodoc-Otto
- KfH-Nierenzentrum Germering, 82110 Germering, Germany; (J.S.-O.); (W.B.); (Y.S.)
| | | | - Marcell Toepfer
- Dialysezentrum Garmisch-Partenkirchen-Murnau-Weilheim, 82418 Murnau, Germany;
| | - Simon Rau
- Dialysezentrum Bad Tölz und Wolfratshausen, 83646 Bad Tölz, Germany; (T.L.); (S.R.)
| | | | - Michael Paal
- Institute of Laboratory Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (F.M.A.); (M.P.); (D.T.); (M.B.)
| | - Wilke Beuthien
- KfH-Nierenzentrum Germering, 82110 Germering, Germany; (J.S.-O.); (W.B.); (Y.S.)
| | - Norbert Thaller
- KfH-Nierenzentrum Miesbach, 83714 Miesbach, Germany; (D.S.-R.); (N.T.)
| | - Yana Suttmann
- KfH-Nierenzentrum Germering, 82110 Germering, Germany; (J.S.-O.); (W.B.); (Y.S.)
| | - Gero von Gersdorff
- QiN-Group, Department II of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany;
| | - Ron Regenauer
- Department of Medicine IV, University Hospital, LMU Munich, 81377 Munich, Germany; (L.F.); (I.L.); (S.H.); (R.R.); (A.v.B.-B.); (M.F.)
| | - Anke von Bergwelt-Baildon
- Department of Medicine IV, University Hospital, LMU Munich, 81377 Munich, Germany; (L.F.); (I.L.); (S.H.); (R.R.); (A.v.B.-B.); (M.F.)
| | - Daniel Teupser
- Institute of Laboratory Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (F.M.A.); (M.P.); (D.T.); (M.B.)
| | - Mathias Bruegel
- Institute of Laboratory Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (F.M.A.); (M.P.); (D.T.); (M.B.)
| | - Michael Fischereder
- Department of Medicine IV, University Hospital, LMU Munich, 81377 Munich, Germany; (L.F.); (I.L.); (S.H.); (R.R.); (A.v.B.-B.); (M.F.)
| | - Ulf Schönermarck
- Department of Medicine IV, University Hospital, LMU Munich, 81377 Munich, Germany; (L.F.); (I.L.); (S.H.); (R.R.); (A.v.B.-B.); (M.F.)
- Correspondence: ; Fax: +49-89-4400-72362
| |
Collapse
|
54
|
Tung KT, Peng YS, Hsu SP, Wu HY, Chiu YL, Yang JY, Pai MF, Shu KH, Pan SY, Lu HM, Lin WY, Liao CH, Chu FY, Tsai WC. Humoral antibody response to the first dose of the ChAdOx1 nCoV-19 vaccine in Asian patients undergoing hemodialysis. Hemodial Int 2022; 26:369-376. [PMID: 35411681 PMCID: PMC9111681 DOI: 10.1111/hdi.13011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/24/2022] [Indexed: 11/28/2022]
Abstract
Background and objectives The immunogenicity of vaccines is known to be attenuated in patients with end‐stage kidney disease due to uremia. Patients on dialysis were excluded from coronavirus disease 2019 (COVID‐19) vaccine trials; thus, the effectiveness of vaccines for this population is unclear. The aim of this study was to explore whether Asian dialysis patients can effectively produce an immune response after being vaccinated with the first dose of the ChAdOx1 nCoV‐19 vaccine. Design setting, participants, and measurements In this prospective cohort study, we included Asian hemodialysis patients who received the ChAdOx1 nCoV‐19 vaccine. At 3 weeks after the first dose of vaccination, we assessed the humoral immune response by measuring anti‐SARS‐CoV‐2 S antibody titers. The primary outcome was the seropositive rate following vaccination, defined as an antibody titer greater than or equal to 0.8 U/ml. Factors associated with seropositivity were explored in multivariate logistic regression analyses. Results In total, 434 participants were included. The mean age was 64 years, the mean dialysis vintage was 6 years, and 61% of the participants were men. At a mean time of 22 days from vaccination, 56% of the participants were seropositive. The vast majority (88%) had low antibody titers (< 15 U/ml). The multivariate logistic regression analyses showed that older age (every increase of 10 years, odds ratio [OR] 0.80, 95% CI 0.65–0.98, p = 0.03) was negatively associated with seropositivity and that higher Kt/V (every increase of 0.1, OR 1.14, 95% CI 1.01–1.28, p = 0.03) and higher serum albumin level (every increase of 0.1 g/dl, OR 1.09, 95% CI 1.02–1.18, p = 0.02) were positively associated with seropositivity. Conclusions In Asian hemodialysis patients, the seropositive rate was low, and most had low antibody titers after the first dose of the ChAdOx1 nCoV‐19 vaccine. Younger age, better dialysis adequacy, and higher albumin levels were associated with seropositivity.
Collapse
Affiliation(s)
- Kuei-Ting Tung
- Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yu-Sen Peng
- Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Department of Applied Cosmetology, Lee-Ming Institute of Technology, New Taipei City, Taiwan.,Department of Healthcare Administration, Asia Eastern University of Science and Technology, New Taipei City, Taiwan
| | - Shih-Ping Hsu
- Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,School of Life Science, National Taiwan Normal University, Taipei City, Taiwan
| | - Hon-Yen Wu
- Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan.,School of Medicine, College of Medicine, National Yang-Ming Chiao Tung University, Taipei City, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei City, Taiwan
| | - Yen-Ling Chiu
- Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Graduate Program in Biomedical Informatics, Yuan Ze University, Taoyuan City, Taiwan
| | - Ju-Yeh Yang
- Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Mei-Fen Pai
- Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Kai-Hsiang Shu
- Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Szu-Yu Pan
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei City, Taiwan.,Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei City, Taiwan
| | - Hui-Ming Lu
- Nursing Department, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Wan-Yu Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Chun-Hsing Liao
- School of Medicine, College of Medicine, National Yang-Ming Chiao Tung University, Taipei City, Taiwan.,Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Fang-Yeh Chu
- Department of Clinical Pathology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Department of Medical Laboratory Science and Biotechnology, Yuanpei University of Medical Technology, Hsinchu City, Taiwan.,Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan City, Taiwan.,School of Medical Laboratory Science and Biotechnology, Taipei Medical University, Taipei City, Taiwan
| | - Wan-Chuan Tsai
- Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Center for General Education, Lee-Ming Institute of Technology, New Taipei City, Taiwan
| |
Collapse
|
55
|
Matsunami M, Suzuki T, Fukuda J, Terao T, Ukai K, Sugihara S, Toishi T, Nagaoka K, Nakata M, Ohara M, Yashima J, Kuji H, Matsue K. Comparison of antibody response following the second dose of SARS-CoV-2 mRNA vaccine in elderly patients with late-stage chronic kidney disease. RENAL REPLACEMENT THERAPY 2022; 8:13. [PMID: 35402003 PMCID: PMC8980785 DOI: 10.1186/s41100-022-00402-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/23/2022] [Indexed: 01/12/2023] Open
Abstract
Background Currently, it is unclear whether the progression of chronic kidney disease (CKD) could be an independent predictor of antibody response after administration of a COVID-19 vaccine. This study aimed to investigate the immune response to COVID-19 vaccination in patients with CKD stage G4 to G5 without renal replacement therapy and G5D using the recommended dose and schedule. Methods This retrospective single-center cohort study evaluated immunogenicity regarding antibody response after COVID-19 vaccination in our hospital for late-stage CKD patients aged ≥ 60 years. We evaluated antibody responses in 48 patients with CKD G4, 35 patients with CKD G5, and 70 patients undergoing hemodialysis (HD; CKD G5D). Results After the second vaccination, anti-SARS-CoV-2-S (Spike) IgG levels were found to be positive (> 0.8 U/mL) in all CKD G4 and G5 patients (100%), and 69 of 70 HD patients (98.5%). The median (interquartile range [IQR] S-IgG level (Ab titers) was 358 [130.2–639.2], 218 [117–377], and 185.5 [95.1–323.5] U/mL in the CKD G4, G5, and HD groups, respectively. The median S-IgG levels were significantly lower in the HD group than in the CKD G4 group (p < 0.01). However, there was no significant difference in the antibody titers between the CKD G4 and G5 groups. To further analyze the decline in S-IgG levels after 6 months, we additionally assessed and compared antibody titers at 1 month and 6 months after the second vaccination in the HD group. Compared with the median S-IgG levels of 185.5 [95.1–323.5] U/mL 1 month after the second dose, the median S-IgG level 6 months thereafter was significantly decreased at 97.4 [62.5–205.5] U/mL (p < 0.05). Conclusions We highlight two major factors of variability in the vaccine response. First, in elderly patients with late-stage CKD, antibody titers tended to be lower in the G5D group than in the G4 and G5 groups despite the shorter time since vaccination; therefore, CKD stage progression might cause a decline in antibody titers. Second, waning immune responses were observed 6 months after second dose administration in HD patients advocating a potential need for a third booster dose vaccine after 6 months.
Collapse
|
56
|
Medina-Pestana J, Covas DT, Viana LA, Dreige YC, Nakamura MR, Lucena EF, Requião-Moura LR, Fortaleza CMCB, Foresto RD, Tedesco-Silva H, Cristelli MP. Inactivated Whole-virus Vaccine Triggers Low Response Against SARS-CoV-2 Infection Among Renal Transplant Patients: Prospective Phase 4 Study Results. Transplantation 2022; 106:853-861. [PMID: 34882589 PMCID: PMC8942595 DOI: 10.1097/tp.0000000000004036] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/18/2021] [Accepted: 11/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Anti-severe acute respiratory syndrome coronavirus 2 mRNA vaccines elicit lower humoral responses in solid-organ transplant recipients. This is the first prospective trial investigating the effect of an inactivated whole-virion vaccine in kidney transplant recipients. METHODS Prospective, single-center, phase 4, interventional study. Kidney transplant recipients aged 30-69 y with >30 d of transplantation received two 3 µg intramuscular doses of CoronaVac 28 d apart and are being followed for 6 mo. Primary outcomes: (1) reactogenicity after first dose; (2) antibody responses 28 d after each dose; and (3) incidence/severity of confirmed coronavirus disease 2019 (COVID-19) and 28-d lethality rate. For this analysis, clinical effectiveness was assessed for 3 mo, starting 15 d after the second dose, and compared with 3-mo period before vaccination. RESULTS Of the 3371 individuals who received the first dose, 99% completed vaccination schedule. Mild/local adverse reactions were reported by 33% of the patients. In the immunogenicity cohort (n = 942), the proportion of patients with IgG antibodies to severe acute respiratory syndrome coronavirus 2 increased from 15.2% after first dose to 43% after second dose. Increase in antibody values after second dose was associated with higher proportion of patients with detected neutralizing antibodies. A significant reduction in the incidence of COVID-19 was observed (6.4% versus 4.2%; P < 0.0001), although the 28-d lethality rate remained unchanged (25% versus 22%; P = 0.534). In 45 patients from the immunogenicity cohort who developed COVID-19, all the 6 deaths occurred among those without antibody response (n = 22; 49%). CONCLUSIONS CoronaVac vaccine was associated with low reactogenicity, low immunogenicity but reduced incidence of COVID-19 among kidney transplant recipients. The lack of reduction in lethality rates is perhaps associated with the low percentage of patients developing humoral response after the second dose.
Collapse
Affiliation(s)
- José Medina-Pestana
- Nephrology Division, Hospital do Rim, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Dimas Tadeu Covas
- Instituto Butantan, São Paulo, Brazil
- Center for Cell-based Therapy (CTC), Regional Blood Center of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Laila Almeida Viana
- Nephrology Division, Hospital do Rim, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Yasmim Cardoso Dreige
- Nephrology Division, Hospital do Rim, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Monica Rika Nakamura
- Nephrology Division, Hospital do Rim, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Elizabeth França Lucena
- Nephrology Division, Hospital do Rim, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Lucio R. Requião-Moura
- Nephrology Division, Hospital do Rim, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | | | - Renato Demarchi Foresto
- Nephrology Division, Hospital do Rim, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Helio Tedesco-Silva
- Nephrology Division, Hospital do Rim, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Marina Pontello Cristelli
- Nephrology Division, Hospital do Rim, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| |
Collapse
|
57
|
Agur T, Ben-Dor N, Herman-Edelstein M, Steinmetz T, Lichtenberg S, Schneider S, Yahav D, Rozen-Zvi B, Zingerman B. Longevity of Humoral Response Six Months Following BNT162b2 Vaccine in Dialysis Patients. Front Med (Lausanne) 2022; 9:781888. [PMID: 35402451 PMCID: PMC8990786 DOI: 10.3389/fmed.2022.781888] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/14/2022] [Indexed: 01/12/2023] Open
Abstract
Background End-stage kidney disease substantially increases the risk of severe COVID-19. However, despite early robust immunogenicity of the mRNA-SARS-CoV-2 vaccination in patients with hemodialysis, the longevity of humoral response in this high-risk population is still unknown. Methods A prospective cohort study aimed to evaluate the longevity of serologic response in patients with hemodialysis, compared with a control group, 6 months following the second dose of the BNT162b2 vaccine. We assessed antibody response by quantitative measurement of IgG antibodies against the receptor-binding domain of the Spike protein (anti-S1-RBD IgG). Study outcomes were defined as a seropositivity rate and log-transformed anti-S1-RBD IgG levels at 6 months, and the change in antibody levels between 3 and 6 months. Findings The cohort included 104 patients with hemodialysis and 84 controls. At a median time of 184 days (IQR, 183–188) following the second dose of the vaccine, 83/104 (79.8%) patients with hemodialysis maintained seropositivity for the anti-S1-RBD IgG level compared to 83/84 (98.8%) in the control group (p < 0.001). The log-transformed antibody level was significantly lower in the hemodialysis group (2.23 ± 0.39 log AU/ml vs. 2.69 ± 0.65 log AU/ml, respectively, p < 0.001). Older age and hypoalbuminemia were the only variables that were found to be associated with reduced log-transformed antibody levels in univariate and multivariate analysis. There was no interaction between dialysis status and an antibody-level decline rate (p = 0.972). Conclusion Among patients with hemodialysis, a seropositivity rate and anti-S1-RBD antibody titers were substantially reduced compared with a control group, at 6 months following the second dose of the BNT162b2 vaccine. These findings support the prioritization of patients with hemodialysis for a third “booster” dose.
Collapse
Affiliation(s)
- Timna Agur
- Department of Nephrology and Hypertension, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- *Correspondence: Timna Agur,
| | - Naomi Ben-Dor
- Department of Nephrology and Hypertension, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Herman-Edelstein
- Department of Nephrology and Hypertension, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tali Steinmetz
- Department of Nephrology and Hypertension, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shelly Lichtenberg
- Department of Nephrology and Hypertension, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shira Schneider
- Department of Nephrology and Hypertension, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dafna Yahav
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Infectious Diseases Unit, Rabin Medical Center, Petah Tikva, Israel
| | - Benaya Rozen-Zvi
- Department of Nephrology and Hypertension, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boris Zingerman
- Department of Nephrology and Hypertension, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
58
|
Chukwu CA, Mahmood K, Elmakki S, Gorton J, Kalra PA, Poulikakos D, Middleton R. Evaluating the antibody response to SARS-COV-2 vaccination amongst kidney transplant recipients at a single nephrology centre. PLoS One 2022; 17:e0265130. [PMID: 35271655 PMCID: PMC8912185 DOI: 10.1371/journal.pone.0265130] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/23/2022] [Indexed: 12/12/2022] Open
Abstract
Background and objectives Kidney transplant recipients are highly vulnerable to the serious complications of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infections and thus stand to benefit from vaccination. Therefore, it is necessary to establish the effectiveness of available vaccines as this group of patients was not represented in the randomized trials. Design, setting, participants, & measurements A total of 707 consecutive adult kidney transplant recipients in a single center in the United Kingdom were evaluated. 373 were confirmed to have received two doses of either the BNT162b2 (Pfizer-BioNTech) or AZD1222 (Oxford-AstraZeneca) and subsequently had SARS-COV-2 antibody testing were included in the final analysis. Participants were excluded from the analysis if they had a previous history of SARS-COV-2 infection or were seropositive for SARS-COV-2 antibody pre-vaccination. Multivariate and propensity score analyses were performed to identify the predictors of antibody response to SARS-COV-2 vaccines. The primary outcome was seroconversion rates following two vaccine doses. Results Antibody responders were 56.8% (212/373) and non-responders 43.2% (161/373). Antibody response was associated with greater estimated glomerular filtration (eGFR) rate [odds ratio (OR), for every 10 ml/min/1.73m2 = 1.40 (1.19–1.66), P<0.001] whereas, non-response was associated with mycophenolic acid immunosuppression [OR, 0.02(0.01–0.11), p<0.001] and increasing age [OR per 10year increase, 0.61(0.48–0.78), p<0.001]. In the propensity-score analysis of four treatment variables (vaccine type, mycophenolic acid, corticosteroid, and triple immunosuppression), only mycophenolic acid was significantly associated with vaccine response [adjusted OR by PSA 0.17 (0.07–0.41): p<0.001]. 22 SARS-COV-2 infections were recorded in our cohort following vaccination. 17(77%) infections, with 3 deaths, occurred in the non-responder group. No death occurred in the responder group. Conclusion Vaccine response in allograft recipients after two doses of SARS-COV-2 vaccine is poor compared to the general population. Maintenance with mycophenolic acid appears to have the strongest negative impact on vaccine response.
Collapse
Affiliation(s)
- Chukwuma A. Chukwu
- Department of Nephrology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- * E-mail:
| | - Kassir Mahmood
- Department of Nephrology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | - Safa Elmakki
- Department of Nephrology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | - Julie Gorton
- Department of Nephrology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | - Phillip A. Kalra
- Department of Nephrology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Dimitrios Poulikakos
- Department of Nephrology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Rachel Middleton
- Department of Nephrology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| |
Collapse
|
59
|
Benning L, Klein K, Morath C, Bartenschlager M, Kim H, Buylaert M, Reineke M, Töllner M, Nusshag C, Kälble F, Reichel P, Schnitzler P, Zeier M, Süsal C, Bartenschlager R, Schaier M, Speer C. Neutralizing Antibody Activity Against the B.1.617.2 (delta) Variant Before and After a Third BNT162b2 Vaccine Dose in Hemodialysis Patients. Front Immunol 2022; 13:840136. [PMID: 35309320 PMCID: PMC8931261 DOI: 10.3389/fimmu.2022.840136] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/11/2022] [Indexed: 12/20/2022] Open
Abstract
Hemodialysis patients are at high risk for severe COVID-19, and impaired seroconversion rates have been demonstrated after COVID-19 vaccination. Humoral immunity wanes over time and variants of concern with immune escape are posing an increasing threat. Little is known about protection against the B.1.617.2 (delta) variant of concern in hemodialysis patients before and after third vaccination. We determined anti-S1 IgG, surrogate neutralizing, and IgG antibodies against different SARS-CoV-2 epitopes in 84 hemodialysis patients directly before and three weeks after a third vaccine dose with BNT162b2. Third vaccination was performed after a median (IQR) of 119 (109–165) days after second vaccination. In addition, neutralizing activity against the B.1.617.2 (delta) variant was assessed in 31 seroconverted hemodialysis patients before and after third vaccination. Triple seropositivity for anti-S1 IgG, surrogate neutralizing, and anti-RBD antibodies increased from 31/84 (37%) dialysis patients after second to 80/84 (95%) after third vaccination. Neutralizing activity against the B.1.617.2 (delta) variant was significantly higher after third vaccination with a median (IQR) ID50 of 1:320 (1:160–1:1280) compared with 1:20 (0–1:40) before a third vaccine dose (P<0.001). The anti-S1 IgG index showed the strongest correlation with the ID50 against the B.1.617.2 (delta) variant determined by live virus neutralization (r=0.91). We demonstrate low neutralizing activity against the B.1.617.2 (delta) variant in dialysis patients four months after standard two-dose vaccination but a substantial increase after a third vaccine dose. Booster vaccination(s) should be considered earlier than 6 months after the second vaccine dose in immunocompromised individuals.
Collapse
Affiliation(s)
- Louise Benning
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
- *Correspondence: Louise Benning,
| | - Katrin Klein
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Christian Morath
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Marie Bartenschlager
- Department of Infectious Diseases, Molecular Virology, University of Heidelberg, Heidelberg, Germany
| | - Heeyoung Kim
- Department of Infectious Diseases, Molecular Virology, University of Heidelberg, Heidelberg, Germany
| | - Mirabel Buylaert
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Marvin Reineke
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | | | - Christian Nusshag
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Florian Kälble
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Paula Reichel
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Paul Schnitzler
- Department of Virology, University of Heidelberg, Heidelberg, Germany
| | - Martin Zeier
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Caner Süsal
- Institute of Immunology, University of Heidelberg, Heidelberg, Germany
- Transplant Immunology Research Center of Excellence, Koç University Hospital, Istanbul, Turkey
| | - Ralf Bartenschlager
- Department of Infectious Diseases, Molecular Virology, University of Heidelberg, Heidelberg, Germany
- German Center for Infection Research, Partner Site Heidelberg, Heidelberg, Germany
- Division Virus-Associated Carcinogenesis, German Cancer Research Center, Heidelberg, Germany
| | - Matthias Schaier
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Claudius Speer
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
- Department of Molecular Medicine Partnership Unit Heidelberg, European Molecular Biology Laboratory, Heidelberg, Germany
| |
Collapse
|
60
|
Tallaa F, Gunaratnam L, Suri R. SARS-CoV-2 Vaccine Mandates for Patients on the Kidney Transplant Waitlist. Clin J Am Soc Nephrol 2022; 17:746-748. [PMID: 35236716 PMCID: PMC9269578 DOI: 10.2215/cjn.15611121] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Faissal Tallaa
- F Tallaa, Internal Medicine Training Program, McGill University, Montreal, Canada
| | - Lakshman Gunaratnam
- L Gunaratnam, Division of Nephrology, Schulich School of Medicine and Dentistry, London, Canada
| | - Rita Suri
- R Suri, Research Institute of the McGill University Health Centre, Montreal, Canada
| |
Collapse
|
61
|
Hsu CM, Weiner DE, Manley HJ, Aweh GN, Ladik V, Frament J, Miskulin D, Argyropoulos C, Abreo K, Chin A, Gladish R, Salman L, Johnson D, Lacson EK. Seroresponse to SARS-CoV-2 Vaccines among Maintenance Dialysis Patients over 6 Months. Clin J Am Soc Nephrol 2022; 17:403-413. [PMID: 35144972 PMCID: PMC8975038 DOI: 10.2215/cjn.12250921] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/05/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Although most patients receiving maintenance dialysis exhibit initial seroresponse to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination, concerns exist regarding the durability of this antibody response. This study evaluated seroresponse over time. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This retrospective cohort study included patients on maintenance dialysis, from a midsize national dialysis provider, who received a complete SARS-CoV-2 vaccine series and had at least one antibody titer checked after full vaccination. IgG spike antibodies (anti-spike IgG) titers were assessed monthly with routine laboratory tests after vaccination; the semiquantitative assay reported a range between zero and ≥20 Index. Descriptive analyses compared trends over time by history of coronavirus disease 2019 (COVID-19) and vaccine type. Time-to-event analyses examined the outcome of loss of seroresponse (anti-spike IgG <1 Index or development of COVID-19). Cox regression adjusted for additional clinical characteristics. RESULTS Among 1870 patients receiving maintenance dialysis, 1569 had no prior COVID-19. Patients without prior COVID-19 had declining titers over time. Among 443 recipients of BNT162b2 (Pfizer), median (interquartile range) anti-spike IgG titer declined from ≥20 (5.89 to ≥20) in month 1 after full vaccination to 1.96 (0.60-5.88) by month 6. Among 778 recipients of mRNA-1273 (Moderna), anti-spike IgG titer declined from ≥20 (interquartile range, ≥20 to ≥20) in month 1 to 7.99 (2.61 to ≥20) by month 6. The 348 recipients of Ad26.COV2.S (Janssen) had a lower titer response than recipients of an mRNA vaccine over all time periods. In time-to-event analyses, recipients of Ad26.COV2.S and mRNA-1273 had the shortest and longest time to loss of seroresponse, respectively. The maximum titer reached in the first 2 months after full vaccination was associated with durability of the anti-spike IgG seroresponse; patients with anti-spike IgG titer 1-19.99 had a shorter time to loss of seroresponse compared with patients with anti-spike IgG titer ≥20 (hazard ratio, 15.5; 95% confidence interval, 11.7 to 20.7). CONCLUSIONS Among patients receiving maintenance dialysis, vaccine-induced seroresponse wanes over time across vaccine types. Early titers after full vaccination are associated with the durability of seroresponse.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Kenneth Abreo
- Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Andrew Chin
- University of California, Davis, Sacramento, California
| | | | | | | | - Eduardo K. Lacson
- Tufts Medical Center, Boston, Massachusetts,Dialysis Clinic Inc., Nashville, Tennessee
| |
Collapse
|
62
|
Yau K, Chan CT, Abe KT, Jiang Y, Atiquzzaman M, Mullin SI, Shadowitz E, Liu L, Kostadinovic E, Sukovic T, Gonzalez A, McGrath-Chong ME, Oliver MJ, Perl J, Leis JA, Bolotin S, Tran V, Levin A, Blake PG, Colwill K, Gingras AC, Hladunewich MA. Differences in mRNA-1273 (Moderna) and BNT162b2 (Pfizer-BioNTech) SARS-CoV-2 vaccine immunogenicity among patients undergoing dialysis. CMAJ 2022; 194:E297-E305. [PMID: 35115375 PMCID: PMC9053976 DOI: 10.1503/cmaj.211881] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Differences in immunogenicity between mRNA SARS-CoV-2 vaccines have not been well characterized in patients undergoing dialysis. We compared the serologic response in patients undergoing maintenance hemodialysis after vaccination against SARS-CoV-2 with BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna). METHODS We conducted a prospective observational cohort study at 2 academic centres in Toronto, Canada, from Feb. 2, 2021, to July 20, 2021, which included 129 and 95 patients who received the BNT162b2 and mRNA-1273 SARS-CoV-2 vaccines, respectively. We measured SARS-CoV-2 immunoglobulin G antibodies to the spike protein (anti-spike), receptor binding domain (anti-RBD) and nucleocapsid protein (anti-NP) at 6-7 and 12 weeks after the second dose of vaccine and compared those levels with the median convalescent serum antibody levels from 211 controls who were previously infected with SARS-CoV-2. RESULTS At 6-7 weeks after 2-dose vaccination, we found that 51 of 70 patients (73%) who received BNT162b2 and 83 of 87 (95%) who received mRNA-1273 attained convalescent levels of anti-spike antibody (p < 0.001). In those who received BNT162b2, 35 of 70 (50%) reached the convalescent level for anti-RBD compared with 69 of 87 (79%) who received mRNA-1273 (p < 0.001). At 12 weeks after the second dose, anti-spike and anti-RBD levels were significantly lower in patients who received BNT162b2 than in those who received mRNA-1273. For anti-spike, 70 of 122 patients (57.4%) who received BNT162b2 maintained the convalescent level versus 68 of 71 (96%) of those who received mRNA-1273 (p < 0.001). For anti-RBD, 47 of 122 patients (38.5%) who received BNT162b2 maintained the anti-RBD convalescent level versus 45 of 71 (63%) of those who received mRNA-1273 (p = 0.002). INTERPRETATION In patients undergoing hemodialysis, mRNA-1273 elicited a stronger humoral response than BNT162b2. Given the rapid decline in immunogenicity at 12 weeks in patients who received BNT162b2, a third dose is recommended in patients undergoing dialysis as a primary series, similar to recommendations for other vulnerable populations.
Collapse
Affiliation(s)
- Kevin Yau
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Christopher T Chan
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Kento T Abe
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Yidi Jiang
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Mohammad Atiquzzaman
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Sarah I Mullin
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Ellen Shadowitz
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Lisa Liu
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Ema Kostadinovic
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Tatjana Sukovic
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Anny Gonzalez
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Margaret E McGrath-Chong
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Matthew J Oliver
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Jeffrey Perl
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Jerome A Leis
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Shelly Bolotin
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Vanessa Tran
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Adeera Levin
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Peter G Blake
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Karen Colwill
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Anne-Claude Gingras
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Michelle A Hladunewich
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont.
| |
Collapse
|
63
|
Milia VL, Tonolo S, Luzzaro F, Bonato C, Limardo M, Longhi S, Ravasi C, Viganò S, Cavalli A. Sustained humoral response six months after the anti-SARS-CoV-2 mRNA-BNT162b2 vaccine in hemodialysis patients: should booster vaccine doses be given in all patients at the same time? Clin Kidney J 2022; 15:1012-1014. [PMID: 35498885 PMCID: PMC9050530 DOI: 10.1093/ckj/sfac047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Silvia Tonolo
- Microbiology Unit, A. Manzoni Hospital, Lecco, Italy
| | | | - Claudio Bonato
- Department of Clinical Services, A. Manzoni Hospital, Lecco, Italy
| | - Monica Limardo
- Nephrology and Dialysis Unit, A. Manzoni Hospital, Lecco, Italy
| | - Selena Longhi
- Nephrology and Dialysis Unit, A. Manzoni Hospital, Lecco, Italy
| | - Chiara Ravasi
- Nephrology and Dialysis Unit, A. Manzoni Hospital, Lecco, Italy
| | - Sara Viganò
- Nephrology and Dialysis Unit, A. Manzoni Hospital, Lecco, Italy
| | - Andrea Cavalli
- Nephrology and Dialysis Unit, A. Manzoni Hospital, Lecco, Italy
| |
Collapse
|
64
|
Bell S, Campbell J, Lambourg E, Watters C, O'Neil M, Almond A, Buck K, Carr E, Clark L, Cousland Z, Findlay M, Joss N, Metcalfe W, Petrie M, Spalding E, Traynor J, Sanu V, Thomson P, Methven S, Mark P. The Impact of Vaccination on Incidence and Outcomes of SARS-CoV-2 Infection in Patients with Kidney Failure in Scotland. J Am Soc Nephrol 2022; 33:677-686. [PMID: 35110363 PMCID: PMC8970454 DOI: 10.1681/asn.2022010046] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 01/15/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Patients with kidney failure requiring kidney replacement therapy (KRT) are at high risk of complications and death following SARS-CoV-2 infection with variable antibody responses to vaccination reported. We investigated the effects of COVID-19 vaccination on incidence of infection, hospitalization and death of COVID-19 infection. Methods: Study design was an observational data linkage cohort study. Multiple healthcare datasets were linked to ascertain all SARS-CoV-2 testing, vaccination, hospitalization, and mortality data for all patients treated with KRT in Scotland, from the start of the pandemic over a period of 20 months. Descriptive statistics, survival analyses, and vaccine effectiveness were calculated. Results: As of 19th September 2021, 93% (n=5281) of the established KRT population in Scotland had received two doses of an approved SARS-CoV-2 vaccine. Over the study period, there were 814 cases of SARS-CoV-2 infection (15.1% of the KRT population). Vaccine effectiveness against infection and hospitalization was 33% (95% CI 0-52) and 38% (95% CI 0-57) respectively. 9.2% of fully vaccinated individuals died within 28 days of a SARS-CoV-2 positive PCR test (7% dialysis patients and 10% kidney transplant recipients). This compares to <0.1% of the vaccinated Scottish population being admitted to hospital or dying death due to COVID19 during that period. Conclusions: These data demonstrate a primary vaccine course of two doses has limited impact on COVID-19 infection and its complications in patients treated with KRT. Adjunctive strategies to reduce risk of both COVID-19 infection and its complications in this population are urgently required.
Collapse
Affiliation(s)
- Samira Bell
- S Bell, Division of Population Health and Genomics, University of Dundee School of Medicine, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - Jacqueline Campbell
- J Campbell, The Scottish Renal Registry, Scottish Health Audits, Public Health Scotland Glasgow Office, Glasgow, United Kingdom of Great Britain and Northern Ireland
| | - Emilie Lambourg
- E Lambourg, Division of Population Health and Genomics, University of Dundee School of Medicine, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - Chrissie Watters
- C Watters, The Scottish Renal Registry, Scottish Health Audits, Public Health Scotland Glasgow Office, Glasgow, United Kingdom of Great Britain and Northern Ireland
| | - Martin O'Neil
- M O'Neil, The Scottish Renal Registry, Scottish Health Audits, Public Health Scotland Glasgow Office, Glasgow, United Kingdom of Great Britain and Northern Ireland
| | - Alison Almond
- A Almond, Renal Unit, Mountainhall Treatment Centre, Dumfries, United Kingdom of Great Britain and Northern Ireland
| | - Katharine Buck
- K Buck, Renal Unit, Victoria Hospital, Kirkcaldy, United Kingdom of Great Britain and Northern Ireland
| | - Edward Carr
- E Carr, Cell Biology of Infection Laboratory, The Francis Crick Institute, London, United Kingdom of Great Britain and Northern Ireland
| | - Laura Clark
- L Clark, Department of Renal Medicine, Aberdeen Royal Infirmary, Aberdeen, United Kingdom of Great Britain and Northern Ireland
| | - Zoe Cousland
- Z Cousland, Renal Unit, Monklands Hospital, Airdrie, United Kingdom of Great Britain and Northern Ireland
| | - Mark Findlay
- M Findlay, Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom of Great Britain and Northern Ireland
| | - Nicola Joss
- N Joss, Renal Unit, Raigmore Hospital, Inverness, United Kingdom of Great Britain and Northern Ireland
| | - Wendy Metcalfe
- W Metcalfe, Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom of Great Britain and Northern Ireland
| | - Michaela Petrie
- M Petrie, Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom of Great Britain and Northern Ireland
| | - Elaine Spalding
- E Spalding, Renal Unit, University Hospital Crosshouse, Kilmarnock, United Kingdom of Great Britain and Northern Ireland
| | - Jamie Traynor
- J Traynor, Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom of Great Britain and Northern Ireland
| | - Vinod Sanu
- V Sanu, Renal Unit, Ninewells Hospital and Medical School, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - Peter Thomson
- P Thomson, Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom of Great Britain and Northern Ireland
| | - Shona Methven
- S Methven, Department of Renal Medicine, Aberdeen Royal Infirmary, Aberdeen, United Kingdom of Great Britain and Northern Ireland
| | - Patrick Mark
- P Mark, Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital Campus, Glasgow, United Kingdom of Great Britain and Northern Ireland
| |
Collapse
|
65
|
Immunogenicity and reactogenicity of homologous mRNA-based and vector-based SARS-CoV-2 vaccine regimens in patients receiving maintenance dialysis. Clin Immunol 2022; 236:108961. [PMID: 35227871 PMCID: PMC8875769 DOI: 10.1016/j.clim.2022.108961] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/27/2022]
Abstract
Patients receiving maintenance dialysis (MD) are vulnerable to COVID-19-related morbidity and mortality. Currently, data on SARS-CoV-2-specific cellular and humoral immunity post-vaccination in this population are scarce. We conducted a prospective single-center study exploring the specific cellular (interferon-γ and interleukin-2 ELISpot assays) and humoral immune responses (dot plot array and chemiluminescent microparticle immunoassay [CMIA]) at 4 weeks and 6 weeks following a single dose or a complete homologous dual dose SARS-CoV-2 vaccine regimen in 60 MD patients (six with a history of COVID-19). Our results show that MD patients exhibit a high seroconversion rate (91.7%) but the anti-spike IgG antibodies (CMIA) tend to wane rapidly after full immunization. Only 51.7% of the patients developed T cell immune response. High anti-spike IgG antibodies may predict a better cellular immunity. While patients with prior COVID-19 showed the best response after one, SARS-CoV-2-naïve patients may benefit from a third vaccine injection.
Collapse
|
66
|
Marinaki S, Degiannis D, Roussos S, Xagas E, Tsoutsoura P, Adamopoulos S, Sypsa V, Chaidaroglou A, Pavlopoulou ID, Hatzakis A, Boletis IN. Head-To-Head Comparison of Response Rates to the Two mRNA SARS-CοV-2 Vaccines in a Large Cohort of Solid Organ Transplant (SOT) Recipients. Vaccines (Basel) 2022; 10:vaccines10020190. [PMID: 35214649 PMCID: PMC8876597 DOI: 10.3390/vaccines10020190] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 02/04/2023] Open
Abstract
Due to their higher risk of developing life-threatening COVID-19 disease, solid organ transplant (SOT) recipients have been prioritized in the vaccination programs of many countries. However, there is increasing evidence of reduced immunogenicity to SARS-CοV-2 vaccination. The present study investigated humoral response, safety, and effectiveness after the two mRNA vaccines in 455 SOT recipients. Overall, the antibody response rate was low, at 39.6%. Higher immunogenicity was detected among individuals vaccinated with the mRNA1273 compared to those with the BNT162b2 vaccine (47% vs. 36%, respectively, p = 0.025) as well as higher median antibody levels of 31 (7, 372) (AU/mL) vs. 11 (7, 215) AU/mL, respectively. Among the covariates assessed, vaccination with the BNT162b2 vaccine, antimetabolite- and steroid-containing immunosuppression, female gender, the type of transplanted organ and older age were factors that negatively influenced immune response. Only mild adverse effects were observed. Our findings confirm poor immunogenicity after vaccination, implicating a reevaluation of vaccination policy in SOT recipients.
Collapse
Affiliation(s)
- Smaragdi Marinaki
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, 11527 Athens, Greece; (E.X.); (P.T.); (I.N.B.)
- Correspondence:
| | - Dimitrios Degiannis
- Molecular Immunopathology and Histocompatibility Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece; (D.D.); (A.C.)
| | - Sotirios Roussos
- Department of Hygiene, Epidemiology & Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 15772 Athens, Greece; (S.R.); (V.S.); (A.H.)
| | - Efstathios Xagas
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, 11527 Athens, Greece; (E.X.); (P.T.); (I.N.B.)
| | - Paraskevi Tsoutsoura
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, 11527 Athens, Greece; (E.X.); (P.T.); (I.N.B.)
| | - Stamatis Adamopoulos
- Heart Failure and Transplant Units, Onassis Cardiac Surgery Center, 17674 Athens, Greece;
| | - Vana Sypsa
- Department of Hygiene, Epidemiology & Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 15772 Athens, Greece; (S.R.); (V.S.); (A.H.)
| | - Antigoni Chaidaroglou
- Molecular Immunopathology and Histocompatibility Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece; (D.D.); (A.C.)
| | - Ioanna D. Pavlopoulou
- Pediatric Research Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, 15772 Athens, Greece;
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology & Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 15772 Athens, Greece; (S.R.); (V.S.); (A.H.)
| | - Ioannis N. Boletis
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, 11527 Athens, Greece; (E.X.); (P.T.); (I.N.B.)
| |
Collapse
|
67
|
Grupper A, Katchman H. SARS-CoV-2 Vaccines: Safety and Immunogenicity in Solid Organ Transplant Recipients and Strategies for Improving Vaccine Responses. CURRENT TRANSPLANTATION REPORTS 2022; 9:35-47. [PMID: 35096509 PMCID: PMC8783189 DOI: 10.1007/s40472-022-00359-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2021] [Indexed: 12/20/2022]
Abstract
Purpose of Review While solid organ transplant (SOT) recipients are at the highest risk for severe complications and increased mortality from COVID19 disease, their vaccination against SARS-CoV-2 remains challenging due to fear of immune-mediated adverse events and suboptimal immune response. Our current review is aimed to summarize current knowledge about the safety and efficacy of SARS-CoV-2 vaccines, describe factors that are correlated with immune response, and discuss strategies to improve vaccine immunogenicity in SOT recipients. Recent Findings SARS-CoV-2 vaccines are safe in SOT recipients and not related to rejection or other major adverse events. The immune response to two doses of vaccine is suboptimal and correlated to age and magnitude of immunosuppression. Administration of a third vaccine dose brings to significant amplification of immune response. Summary This review strengthens the existing recommendation of vaccination by three doses of vaccine in all SOT recipients and completion of vaccination before transplantation if possible.
Collapse
|
68
|
Acute Kidney Allograft Rejection Following Coronavirus mRNA Vaccination: A Case Report. Transplant Direct 2022; 8:e1274. [PMID: 35047661 PMCID: PMC8759614 DOI: 10.1097/txd.0000000000001274] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/13/2021] [Accepted: 11/16/2021] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is available in the text.
Collapse
|
69
|
Nafar M, Chehrazi S, Dalili N, Firouzan A, Poorrezagholi F, Samadian F, Samavat S. Humoral Immunity of BBIBP-CorV (Sinopharm) in kidney transplant recipients: Is it time to revise vaccination strategies. Transpl Infect Dis 2022; 24:e13798. [PMID: 35061293 DOI: 10.1111/tid.13798] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/01/2022] [Accepted: 01/11/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The mortality of COVID-19 is high in transplant patients, and effective vaccination is aimed to reduce severe disease and mortality. METHODS We conducted a cross-sectional study to evaluate humoral and cellular response to two 4μg-doses of BBIBP-CorV vaccine in 100 kidney transplant recipients, using Anti-Spike IgG, Total Anti-RBD, Neutralizing Ab level (ELISA), and interferon-gamma release assay (IGRA). RESULTS Seroconversion was evaluated 85.84 ± 30.72 days after second dose. 58% of all and 43.05% infection-naïve participants have developed at least one of the tested antibodies. IGRA was positive in 30.7% of tested transplant recipients. 60% of the participants had either humoral or cellular response to COIVD-19. Only age was independently linked to seropositivity of any degree after vaccination (p<0.05). COVID-naïve patients older than 60 years developed significantly less neutralizing antibody. (p value: 0.011). Six patients developed mild COVID infection more than a month after 2nd dose of vaccine (54.5 ± 20.8 days). No vaccine-related adverse effects were reported, except self-limited mild to moderate fever and injection site pain. CONCLUSION BBIBP-CorV vaccine can be used safely in kidney transplant recipient, although impaired cellular and humoral immunity necessitates adjustments in vaccination strategies, like higher (8μg-doses), forth booster dose, or boost with different platform vaccine. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Mohsen Nafar
- Professor of Nephrology, Chronic Kidney Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saghar Chehrazi
- Chronic Kidney Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Nephrology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nooshin Dalili
- Assistant Professor of Nephrology, Chronic Kidney Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Nephrology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Firouzan
- Associate Professor of Nephrology, Chronic Kidney Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Nephrology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Poorrezagholi
- Associate Professor of Nephrology, Chronic Kidney Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Nephrology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Samadian
- Associate Professor of Nephrology, Chronic Kidney Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Nephrology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shiva Samavat
- Associate professor of nephrology, Urology Nephrology Research Center (UNRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
70
|
Carruthers JE, Wells J, Gupta A, Kallon D, Cox A, Pina N, Yaqoob MM, Rajakariar R. Response to Vaccination Against SARS-CoV-2 in Patients With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis With Renal Involvement. Front Med (Lausanne) 2022; 8:817845. [PMID: 35127773 PMCID: PMC8811045 DOI: 10.3389/fmed.2021.817845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/28/2021] [Indexed: 11/21/2022] Open
Abstract
Background Patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) present with multisystem disease including renal impairment. The treatment for AAV involves a high burden of immunosuppression. Patients with renal involvement are treated especially intensively. As a result, we identified these patients as being potentially at high risk of failure to seroconvert to COVID-19 vaccination. Methods We collected data on seroconversion response rates to COVID-19 vaccination in a multi-ethnic cohort of patients with AAV and renal involvement treated at a busy tertiary nephrology centre as part of a retrospective review of patient notes. Blood samples were taken following vaccination with either Pfizer or Astra-Zeneca COVID-19 vaccines and median fluorescence intensity was measured using the validated MULTICOV-Ab Magnetic LuminexⓇ Assay. We also evaluated whether seroconversion was affected by immunosuppression regimen. Results 81 patients were included. The mean age was 62, and there were 49 (60%) females. 55 patients had a blood test after the first dose; 46 after the second dose. Patients were in remission with a median BVAS of 0 (IQR 2). Seroconversion after the first dose with either vaccine was 35/55 (63.6%). After the second it was 38/46 (82.6%). Subgroup analyses revealed a trend to impaired seroconversion in non-white versus white patients (77.8 vs. 81.7% (p = 0.69) after the first dose of vaccine and in those treated with Rituximab in the last 12 months (73.3 vs. 87.1%, p = 0.41). Conclusions These data offer real-world evidence of lower seroconversion in response to vaccination with one dose in patients with AAV and renal involvement than the general UK population. After two doses, seroconversion is in line with national data. These data provide a rationale for hospital-led identification of patients most at risk of COVID-19 and underscore the importance of local connexions between hospitals and their communities. These data provide further support for targeting booster vaccination programmes to vulnerable patient cohorts. They add to the growing evidence of reduced seroconversion in response to vaccination in patients with renal disease of any cause.
Collapse
Affiliation(s)
- Jack E. Carruthers
- Department of Renal Medicine and Transplantation, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
- The Francis Crick Institute, University College London, London, United Kingdom
| | - James Wells
- Department of Renal Medicine and Transplantation, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Arun Gupta
- Department of Renal Medicine and Transplantation, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Delordson Kallon
- Department of Renal Medicine and Transplantation, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Amber Cox
- Department of Renal Medicine and Transplantation, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Neuza Pina
- Department of Renal Medicine and Transplantation, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Muhammad Magdi Yaqoob
- Department of Renal Medicine and Transplantation, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
- Queen Mary University of London, London, United Kingdom
| | - Ravindra Rajakariar
- Department of Renal Medicine and Transplantation, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
- *Correspondence: Ravindra Rajakariar
| |
Collapse
|
71
|
Piñana JL, López‐Corral L, Martino R, Montoro J, Vazquez L, Pérez A, Martin‐Martin G, Facal‐Malvar A, Ferrer E, Pascual M, Sanz‐Linares G, Gago B, Sanchez‐Salinas A, Villalon L, Conesa‐Garcia V, Olave MT, López‐Jimenez J, Marcos‐Corrales S, García‐Blázquez M, Garcia‐Gutiérrez V, Hernández‐Rivas JÁ, Saus A, Espigado I, Alonso C, Hernani R, Solano C, Ferrer‐Lores B, Guerreiro M, Ruiz‐García M, Muñoz‐Bellido JL, Navarro D, Cedillo A, Sureda A. SARS-CoV-2-reactive antibody detection after SARS-CoV-2 vaccination in hematopoietic stem cell transplant recipients: Prospective survey from the Spanish Hematopoietic Stem Cell Transplantation and Cell Therapy Group. Am J Hematol 2022; 97:30-42. [PMID: 34695229 PMCID: PMC8646900 DOI: 10.1002/ajh.26385] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/17/2021] [Accepted: 10/20/2021] [Indexed: 02/06/2023]
Abstract
This is a multicenter prospective observational study that included a large cohort (n = 397) of allogeneic (allo‐HSCT; (n = 311) and autologous (ASCT) hematopoietic stem cell transplant (n = 86) recipients who were monitored for antibody detection within 3–6 weeks after complete severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) vaccination from February 1, 2021, to July 20, 2021. Most patients (n = 387, 97.4%) received mRNA‐based vaccines. Most of the recipients (93%) were vaccinated more than 1 year after transplant. Detectable SARS‐CoV‐2‐reactive antibodies were observed in 242 (78%) of allo‐HSCT and in 73 (85%) of ASCT recipients. Multivariate analysis in allo‐HSCT recipients identified lymphopenia < 1 × 109/ml (odds ratio [OR] 0.33, 95% confidence interval [95% CI] 0.16–0.69, p = .003), active graft versus host disease (GvHD; OR 0.51, 95% CI 0.27–0.98, p = .04) and vaccination within the first year of transplant (OR 0.3, 95% CI 0.15–0.9, p = .04) associated with lower antibody detection whereas. In ASCT, non‐Hodgkin's lymphoma (NHL; OR 0.09, 95% CI 0.02–0.44, p = .003) and active corticosteroid therapy (OR 0.2, 95% CI 0.02–0.87, p = .03) were associated with lower detection rate. We report an encouraging rate of SARS‐CoV‐2‐reactive antibodies detection in these severe immunocompromised patients. Lymphopenia, GvHD, the timing of vaccine, and NHL and corticosteroids therapy should be considered in allo‐HSCT and ASCT, respectively, to identify candidates for SARS‐CoV‐2 antibodies monitoring.
Collapse
Affiliation(s)
- José Luis Piñana
- Hematology Department Hospital Clínico Universitario de Valencia Valencia Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia Valencia Spain
| | | | - Rodrigo Martino
- Hematology Division Hospital de la Santa Creu i Sant Pau Barcelona Spain
| | - Juan Montoro
- Hematology Division Hospital universitario y politécnico La Fe Valencia Spain
| | - Lourdes Vazquez
- Hematology Division Hospital Universitario de Salamanca Salamanca Spain
| | - Ariadna Pérez
- Hematology Department Hospital Clínico Universitario de Valencia Valencia Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia Valencia Spain
| | | | - Ana Facal‐Malvar
- Hematology Division Hospital universitario y politécnico La Fe Valencia Spain
| | - Elena Ferrer
- Hematology Department Hospital Clínico Universitario de Valencia Valencia Spain
| | - María‐Jesús Pascual
- Hematology Division Hospital Regional Universitario Carlos Haya Malaga Spain
| | - Gabriela Sanz‐Linares
- Hematology Division Institut Català Oncologia‐Hospital Duran i reynals Barcelona Spain
| | - Beatriz Gago
- Hematology Division Hospital Regional Universitario Carlos Haya Malaga Spain
| | | | - Lucia Villalon
- Hematology Division Hospital Universitario Fundación Alcorcón Madrid Spain
| | | | - Maria T. Olave
- Hematology Division Hospital Clínico Universitario Lozano Blesa IIS Aragon, Zaragoza Spain
| | | | | | | | | | | | - Ana Saus
- Hematology Department Hospital Clínico Universitario de Valencia Valencia Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia Valencia Spain
| | - Ildefonso Espigado
- Hematology Division Universidad de Sevilla, Hospital Universitario Virgen Macarena‐Hospital Universitario Virgen del Rocío, IBiS/CSIC Sevilla Spain
| | - Carmen Alonso
- Hematology Division Hospital Arnau de Vilanova Valencia Spain
| | - Rafael Hernani
- Hematology Department Hospital Clínico Universitario de Valencia Valencia Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia Valencia Spain
| | - Carlos Solano
- Hematology Department Hospital Clínico Universitario de Valencia Valencia Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia Valencia Spain
- Department of Medicine, School of Medicine University of Valencia Valencia Spain
| | - Blanca Ferrer‐Lores
- Hematology Department Hospital Clínico Universitario de Valencia Valencia Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia Valencia Spain
| | - Manuel Guerreiro
- Hematology Division Hospital universitario y politécnico La Fe Valencia Spain
| | | | | | - David Navarro
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia Valencia Spain
- Microbiology department Hospital Clinico Universitario de Valencia Valencia Spain
| | - Angel Cedillo
- Hematopoietic Stem Cell Transplantation and Cell Therapy Group (GETH) Madrid Spain
| | - Anna Sureda
- Hematology Division Institut Català Oncologia‐Hospital Duran i reynals Barcelona Spain
| | | |
Collapse
|
72
|
Marinaki S, Xagas E, Tsoutsoura P, Katsaros D, Korogiannou M, Boletis IN. Occurrence of Severe SARS-CoV-2 Infection in Fully Vaccinated Solid Organ Transplant Recipients. Transplant Proc 2021; 54:1405-1408. [PMID: 35074163 PMCID: PMC8718957 DOI: 10.1016/j.transproceed.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/14/2021] [Accepted: 12/27/2021] [Indexed: 10/26/2022]
Abstract
The present study presents the clinical outcome of SARS-CoV-2 disease in relation to the humoral response in fully vaccinated solid organ transplant (SOT) recipients. Our patient cohort consists of 455 SOT recipients, vaccinated with one of the 2 approved mRNA vaccines. The antibody response was measured 1 month after the second dose, and previously infected patients have been excluded. Of the 449 remaining patients, 15 (3.34%) tested positive, using SARS-CoV-2 polymerase chain reaction. Their mean age was 43.7 ±14.4 years, and median time from transplantation was 7.8 years (1.2-30.2). Eleven patients (73.3%) had been vaccinated with BNT162b2 and 4 (26.7%) with the mRNA1273 vaccine. At the time of infection 9 (60%) patients had a negative (<50 AU/mL) antibody titer, and 6 (40%) had a positive one (>50 AU/mL). Median antibody titer, 27.4± 14.0 days after the second dose, measured at 13 AU/mL (0-7480 AU/mL). Renal function did not appear to be affected by the disease. Τhe mean estimated glomerular filtration rate at diagnosis was 48 ± 15 mL/min, and when in a 29-day (1-101) median follow-up was 53.9± 20.9 mL/min. Of the 15 patients, 7 had mild symptoms and were not hospitalized, and of the remaining 8 (53.3%) who needed hospitalization 7 had severe disease and 2 of them expired. The study confirms the variable and often severe course of coronavirus 2019 infection in SOT recipients, even after their full vaccination, highlighting the need to vaccinate their close relatives and to accelerate the implementation of the booster dose of vaccine.
Collapse
Affiliation(s)
- Smaragdi Marinaki
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece
| | - Efstathios Xagas
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece.
| | - Paraskevi Tsoutsoura
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece
| | - Dimitrios Katsaros
- and Medical School of Athens, National and Kapodistrian University, Athens, Greece
| | - Maria Korogiannou
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece
| | - Ioannis N Boletis
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece
| |
Collapse
|
73
|
Benning L, Morath C, Bartenschlager M, Reineke M, Töllner M, Nusshag C, Kälble F, Reichel P, Schaier M, Schnitzler P, Zeier M, Süsal C, Bartenschlager R, Speer C. Natural SARS-CoV-2 infection results in higher neutralization response against variants of concern compared to two-dose BNT162b2 vaccination in kidney transplant recipients. Kidney Int 2021; 101:639-642. [PMID: 34954213 PMCID: PMC8695512 DOI: 10.1016/j.kint.2021.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/18/2021] [Accepted: 12/16/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Louise Benning
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany.
| | - Christian Morath
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Marie Bartenschlager
- Department of Infectious Diseases, Molecular Virology, University of Heidelberg, Heidelberg, Germany
| | - Marvin Reineke
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | | | - Christian Nusshag
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Florian Kälble
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Paula Reichel
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Matthias Schaier
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Paul Schnitzler
- Department of Virology, University of Heidelberg, Heidelberg, Germany
| | - Martin Zeier
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Caner Süsal
- Institute of Immunology, University of Heidelberg, Heidelberg, Germany; Transplant Immunology Research Center of Excellence, Koç University Hospital, Istanbul, Turkey
| | - Ralf Bartenschlager
- Department of Infectious Diseases, Molecular Virology, University of Heidelberg, Heidelberg, Germany; German Center for Infection Research, Partner Site Heidelberg, Heidelberg, Germany; Division Virus-Associated Carcinogenesis, German Cancer Research Center, Heidelberg, Germany
| | - Claudius Speer
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany; Department of Molecular Medicine Partnership Unit Heidelberg, European Molecular Biology Laboratory, Heidelberg, Germany
| |
Collapse
|
74
|
Stauss M, Dhaygude A, Ponnusamy A, Myers M, Woywodt A. Remote Digital Urinalysis With Smartphone Technology as Part of Remote Management of Glomerular Disease During the SARS-CoV-2 Virus Pandemic: Single Centre Experience in 25 Patients. Clin Kidney J 2021; 15:903-911. [PMID: 35498887 PMCID: PMC9050594 DOI: 10.1093/ckj/sfab286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Indexed: 11/14/2022] Open
Abstract
Background The COVID-19 pandemic has necessitated the provision of healthcare through remote and increasingly digitalized means. The management of glomerular pathology, for which urinalysis is crucial, has been notably affected. Here we describe our single-centre experience of using remote digital urinalysis in the management of patients with glomerular disease during the COVID-19 pandemic. Method All patients with native kidney glomerular disease who consented to participate in digital smartphone urinalysis monitoring between March 2020 and July 2021 were included. Electronic health records were contemporaneously reviewed for outcome data. Patient feedback was obtained through the testing portal. Results Twenty-five patients utilized the digital urinalysis application. A total of 105 digital urinalysis tests were performed for a wide variety of indications. Four patients experienced a relapse (detected remotely) and two patients underwent three successful pregnancies. The majority of patients were managed virtually (60%) or virtually and face to face (F2F) combined (32%). The average number of clinic reviews and urine tests performed during the pandemic either virtually and/or F2F was comparable to levels pre-pandemic and the ratio of reviews to urinalysis (R:U) was stable (pre-pandemic 1:0.9 versus during the pandemic 1:0.8). Patients seen exclusively F2F with supplementary home monitoring had the highest R:U ratio at 1:2.1. A total of 95% of users provided feedback, all positive. Conclusion Remote urinalysis proved a safe and convenient tool to facilitate decision-making where traditional urinalysis was difficult, impractical or impossible. Our approach allowed us to continue care in this vulnerable group of patients despite a lack of access to traditional urinalysis.
Collapse
Affiliation(s)
- Madelena Stauss
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
- Division of Medical Education, School of Medical Sciences, University of Manchester
| | - Ajay Dhaygude
- Division of Medical Education, School of Medical Sciences, University of Manchester
| | - Arvind Ponnusamy
- Division of Medical Education, School of Medical Sciences, University of Manchester
| | - Martin Myers
- Department of Clinical Biochemistry, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Alexander Woywodt
- Division of Medical Education, School of Medical Sciences, University of Manchester
| |
Collapse
|
75
|
Beilhack G, Monteforte R, Frommlet F, Gaggl M, Strassl R, Vychytil A. Antibody Response and Safety After mRNA-1273 SARS-CoV-2 Vaccination in Peritoneal Dialysis Patients - the Vienna Cohort. Front Immunol 2021; 12:780594. [PMID: 34925359 PMCID: PMC8674530 DOI: 10.3389/fimmu.2021.780594] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/11/2021] [Indexed: 11/21/2022] Open
Abstract
Background Dialysis patients are at high risk for a severe clinical course after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Safety and early immune responses after mRNA-based vaccination have been reported mostly in patients on hemodialysis (HD), whereas reports of peritoneal dialysis (PD) patients remain rare. Methods In this retrospective observational study, 39 PD patients had received two doses of the mRNA-1273 Moderna® vaccine. We analyzed SARS-CoV-2 Spike (S) antibody titers 4 weeks after each dose of mRNA-1273 and report local and systemic side effects in PD patients that occurred within one week after each mRNA-1273 dose. Using a quantile regression model we examined factors that might influence SARS-CoV-2 S antibody levels in PD patients. Results Four weeks after the first dose of mRNA-1273 vaccine 33 of 39 (84.6%) PD patients seroconverted and presented with 6.62 U/mL (median; IQR 1.57-22.5) anti-SARS-CoV-2 S antibody titers. After the second dose, 38 of 39 (97.4%) PD patients developed anti-SARS-CoV-2 S antibodies and titers increased significantly (median 968 U/mL; IQR 422.5-2500). Pain at the injection site was the most common local adverse event (AE) (71%). Systemic AEs occurring after the first dose were mostly fatigue (33%) and headache (20%). No severe systemic AEs were reported after the first injection. After the second dose the incidence and the severity of the systemic AEs increased. The most common systemic AEs were: fatigue (40.5%), headache (22.5%), joint pain (20%), myalgia (17.5%) and fever (13%). Lower Davies Comorbidity Score (p=0.04) and shorter dialysis vintage (p=0.017) were associated with higher antibody titers after the first dose. Patients with higher antibody titers after the first dose tended to have higher antibody titers after the second dose (p=1.53x10-05). Conclusions Peritoneal dialysis patients in this cohort had a high seroconversion rate of 97.4%, showed high antibody titers after full vaccination and tolerated the anti-SARS-CoV-2 mRNA-1273 vaccine well without serious adverse events.
Collapse
Affiliation(s)
- Georg Beilhack
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Rossella Monteforte
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Florian Frommlet
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Martina Gaggl
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Robert Strassl
- Division of Clinical Virology, Medical University of Vienna, Vienna, Austria
| | - Andreas Vychytil
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
76
|
Wijtvliet VPWM, Ariën KK, Abrams S, Couttenye MM, Mestrez F, Mariën J, De Winter BY, Van Damme P, Pipeleers L, Wissing KM, Abramowicz D, Ledeganck KJ. mRNA-1273 vaccine (Moderna): a better option than BNT162b2 (Pfizer) in kidney transplant recipients and dialysis patients? Nephrol Dial Transplant 2021; 37:799-803. [PMID: 34888697 DOI: 10.1093/ndt/gfab352] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Veerle P W M Wijtvliet
- Laboratory of Experimental Medicine and Pediatrics and member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium.,Department of Nephrology and Hypertension, Antwerp University Hospital, Edegem, Belgium
| | - Kevin K Ariën
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Steven Abrams
- Department of Epidemiology and Social Medicine, Global Health Institute, University of Antwerp, Antwerp, Belgium.,I-BioStat, Data Science Institute, Hasselt University, Diepenbeek, Belgium
| | - Marie M Couttenye
- Laboratory of Experimental Medicine and Pediatrics and member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium.,Department of Nephrology and Hypertension, Antwerp University Hospital, Edegem, Belgium
| | - Fabienne Mestrez
- Department of Nephrology-Dialysis, University Hospital (CHU) Ambroise Paré, Mons, Belgium
| | - Joachim Mariën
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Evolutionary Ecology Group, Department of Biology, University of Antwerp, Antwerp, Belgium
| | - Benedicte Y De Winter
- Laboratory of Experimental Medicine and Pediatrics and member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Lissa Pipeleers
- Department of Nephrology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Karl Martin Wissing
- Department of Nephrology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Daniel Abramowicz
- Laboratory of Experimental Medicine and Pediatrics and member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium.,Department of Nephrology and Hypertension, Antwerp University Hospital, Edegem, Belgium
| | - Kristien J Ledeganck
- Laboratory of Experimental Medicine and Pediatrics and member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
77
|
Boongird S, Chuengsaman P, Setthaudom C, Nongnuch A, Assanatham M, Phanprasert S, Kitpermkiat R, Kiertiburanakul S, Malathum K, Phuphuakrat A, Davenport A, Bruminhent J. Short-Term Immunogenicity Profiles and Predictors for Suboptimal Immune Responses in Patients with End-Stage Kidney Disease Immunized with Inactivated SARS-CoV-2 Vaccine. Infect Dis Ther 2021; 11:351-365. [PMID: 34859359 PMCID: PMC8639296 DOI: 10.1007/s40121-021-00574-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/23/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Patients with end-stage kidney disease (ESKD) are at risk of severe coronavirus disease and mortality. Immunogenicity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) inactivated whole-virus vaccine in patients with ESKD has never been explored. METHODS We conducted a prospective cohort study of 60 patients with ESKD and 30 healthy controls. All participants received two doses of an inactivated whole-virus SARS-CoV-2 vaccine (Sinovac Biotech Ltd) 4 weeks apart. SARS-CoV-2-specific humoral and cell-mediated immune responses were investigated and referenced with healthy controls. RESULTS After two doses, an anti-receptor-binding domain immunoglobulin G of 50 AU/ml or greater was present in 53 of 60 patients (88%) in the ESKD group and all participants (100%) in the control group (P = 0.05). The percentage of patients with ESKD and controls with neutralizing antibodies of 35% threshold or greater was 58% and 88%, respectively (P = 0.01). Furthermore, the proportion of patients with ESKD and S1-specific T cell response was comparable with controls (82% vs. 77%, P = 0.45). Old age, high ferritin level, and low absolute lymphocyte count were independently associated with poor humoral immune responses. CONCLUSIONS Patients with ESKD could develop similar SARS-CoV-2-specific cell-mediated immune responses compared to healthy controls, although suboptimal humoral immune responses were observed following two doses of SARS-CoV-2 vaccination. Therefore, patients with ESKD and the abovementioned factors are at risk of generating inadequate humoral immune responses, and a vaccine strategy to elicit greater immunogenicity among these relatively immunocompromised patients is warranted. (Thai Clinical Trials Registry, TCTR20210226002).
Collapse
Affiliation(s)
- Sarinya Boongird
- Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Piyatida Chuengsaman
- Banphaeo-Charoenkrung Peritoneal Dialysis Center, Banphaeo Dialysis Group, Banphaeo Hospital, Bangkok, Thailand
| | - Chavachol Setthaudom
- Immunology Laboratory, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Arkom Nongnuch
- Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Montira Assanatham
- Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Salinnart Phanprasert
- Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Rungthiwa Kitpermkiat
- Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sasisopin Kiertiburanakul
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Kumthorn Malathum
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Angsana Phuphuakrat
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital, University College London, London, UK
| | - Jackrapong Bruminhent
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.
| |
Collapse
|
78
|
Yadav AK, Gondil VS, Singla M, Goyal A, Kaushal R, Chauhan M, Jha V. Humoral Response to One and Two Doses of ChAdOx1-S Vaccine in Patients on Hemodialysis. Clin J Am Soc Nephrol 2021; 16:1875-1876. [PMID: 34544681 PMCID: PMC8729479 DOI: 10.2215/cjn.10170721] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Ashok Kumar Yadav
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vijay Singh Gondil
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | | | - Vivekanand Jha
- George Institute for Global Health, UNSW, New Delhi, India,School of Public Health, Imperial College, London, United Kingdom,Manipal Academy of Higher Education, Manipal, India
| |
Collapse
|
79
|
The COVID-19 pandemic and ANCA-associated vasculitis - reports from the EUVAS meeting and EUVAS education forum. Autoimmun Rev 2021; 20:102986. [PMID: 34718165 PMCID: PMC8552556 DOI: 10.1016/j.autrev.2021.102986] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 07/24/2021] [Indexed: 01/17/2023]
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic influenced the management of patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis. A paucity of data exists on outcome of patients with vasculitis following COVID-19, but mortality is higher than in the general population and comparable to patients undergoing haemodialysis or kidney transplant recipients (reported mortality rates of 20-25%). Delays in diagnosis have been reported, which are associated with sequelae such as dialysis-dependency. Management of ANCA-associated vasculitis has not changed with the aim to suppress disease activity and reduce burden of disease. The use of rituximab, an important and widely used agent, is associated with a more severe hospital course of COVID-19 and absence of antibodies following severe acute respiratory syndrome (SARS)-CoV-2 infections, which prone patients to re-infection. Reports on vaccine antibody response are scarce at the moment, but preliminary findings point towards an impaired immune response, especially when patients receive rituximab as part of their treatment. Seropositivity was reported in less than 20% of patients when rituximab was administered within the prior six months, and the antibody response correlated with CD19+ B-cell repopulation. A delay in maintenance doses, if disease activity allows, has been suggested using a CD19+ B-cell guided strategy. Other immunosuppressive measures, which are used in ANCA-associated vasculitis, also impair humoral and cellular vaccine responses. Regular measurements of vaccine response or a healthcare-policy time-based strategy are indicated to provide additional doses ("booster") of COVID-19 vaccines. This review summarizes a recent educational forum and a recent virtual meeting of the European Vasculitis Society (EUVAS) focusing on COVID-19.
Collapse
|
80
|
Quiroga B, Soler MJ, Ortiz A, Vaquera SM, Mantecón CJJ, Useche G, Márquez MGS, Carnerero M, Rodríguez MTJ, Ramos PM, Millán JCRS, Toapanta N, Gracia-Iguacel C, Cervera MCA, Lara NB, Leyva A, Rojas J, Gansevoort RT, de Sequera P. Safety and immediate humoral response of COVID-19 vaccines in chronic kidney disease patients: the SENCOVAC study. Nephrol Dial Transplant 2021; 37:1868-1878. [PMID: 34788858 PMCID: PMC8767866 DOI: 10.1093/ndt/gfab313] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background Chronic kidney disease (CKD) patients are at high-risk for severe Covid-19. The multicentric, observational and prospective SENCOVAC study aims to describe the humoral response and safety of SARS-CoV-2 vaccines in CKD patients. Safety and immediate humoral response results are reported here. Methods Four cohorts of patients were included: kidney transplant (KT) recipients, haemodialysis (HD), peritoneal dialysis (PD) and non-dialysis CKD patients from 50 Spanish centres. Adverse events after vaccine doses were recorded. At baseline and on day 28 after the last vaccine dose, anti-Spike antibodies were measured and compared between cohorts. Factors associated with development of anti-Spike antibodies were analyzed. Results 1746 participants were recruited: 1116 HD, 171 PD, 176 non-dialysis CKD patients and 283 KT recipients. Most patients (98%) received mRNA vaccines. At least one vaccine reaction developed after the first dose in 763 (53.5%) and after the second dose in 741 (54.5%) of patients. Anti-Spike antibodies were measured in the first 301 patients. At 28 days, 95% of patients had developed antibodies: 79% of KT, 98% of HD, 99% of PD and 100% of non-dialysis CKD patients (p<0.001). In a multivariate adjusted analysis, absence of an antibody response was independently associated to KT (OR 20.56, p = 0.001) and to BNT162b2 vaccine (OR 6.03, p = 0.023). Conclusion The rate of anti-Spike antibody development after vaccination in KT patients was low but in other CKD patients it approached 100%; suggesting that KT patients require persistent isolation measures and booster doses of a Covid-19 vaccine. Potential differences between Covid-19 vaccines should be explored in prospective controlled studies.
Collapse
Affiliation(s)
- Borja Quiroga
- Nephrology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - María José Soler
- Nephrology Department, Vall d'Hebrón University Hospital, Barcelona, Spain
| | - Alberto Ortiz
- IIS-Fundación Jimenez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Alvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | | | | | | | | | | | | | | | | | - Nestor Toapanta
- Nephrology Department, Vall d'Hebrón University Hospital, Barcelona, Spain
| | - Carolina Gracia-Iguacel
- IIS-Fundación Jimenez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Alvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | | | - Noelia Balibrea Lara
- Nephrology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Alba Leyva
- R&D Department, VIRCELL SL, Granada, Spain
| | - José Rojas
- R&D Department, VIRCELL SL, Granada, Spain
| | - Ron T Gansevoort
- Dept. Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | |
Collapse
|
81
|
Stumpf J, Hugo C. Humoral immunity to SARS-CoV-2 vaccination in haemodialysis patients-Authors´ Reply. THE LANCET REGIONAL HEALTH. EUROPE 2021; 10:100244. [PMID: 34723235 PMCID: PMC8547805 DOI: 10.1016/j.lanepe.2021.100244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Julian Stumpf
- Medizinische Klinik und Poliklinik III, Universitätsklinikum, Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- KfH-Nierenzentrum Dresden, Dresden, Germany
| | - Christian Hugo
- Medizinische Klinik und Poliklinik III, Universitätsklinikum, Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- KfH-Nierenzentrum Dresden, Dresden, Germany
| |
Collapse
|
82
|
Davidovic T, Schimpf J, Abbassi-Nik A, Stockinger R, Sprenger-Mähr H, Lhotta K, Zitt E. Waning humoral response 6 months after SARS-CoV-2 vaccination with the mRNA-BNT162b2 vaccine in hemodialysis patients: time for a boost. Kidney Int 2021; 100:1334-1335. [PMID: 34656642 PMCID: PMC8516134 DOI: 10.1016/j.kint.2021.10.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/27/2021] [Accepted: 10/06/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Tamara Davidovic
- Department of Internal Medicine 3 (Nephrology and Dialysis), Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Judith Schimpf
- Department of Internal Medicine 3 (Nephrology and Dialysis), Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Armin Abbassi-Nik
- Department of Internal Medicine 3 (Nephrology and Dialysis), Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Richard Stockinger
- Institute of Pathology, Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Hannelore Sprenger-Mähr
- Department of Internal Medicine 3 (Nephrology and Dialysis), Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Karl Lhotta
- Department of Internal Medicine 3 (Nephrology and Dialysis), Feldkirch Academic Teaching Hospital, Feldkirch, Austria; Vorarlberg Institute for Vascular Investigation and Treatment, Feldkirch, Austria
| | - Emanuel Zitt
- Department of Internal Medicine 3 (Nephrology and Dialysis), Feldkirch Academic Teaching Hospital, Feldkirch, Austria; Vorarlberg Institute for Vascular Investigation and Treatment, Feldkirch, Austria; Agency for Preventive and Social Medicine, Bregenz, Austria.
| |
Collapse
|
83
|
Holt SG, Mahmoud S, Ahmed W, Acuna JM, Al Madani AK, Eltantawy I, Zaher WA, Goodier GJ, Al Kaabi NA, Al Obaidli AA. An analysis of antibody responses and clinical sequalae of the Sinopharm HB02 COVID19 vaccine in dialysis patients in the United Arab Emirates. Nephrology (Carlton) 2021; 27:260-268. [PMID: 34569677 PMCID: PMC8646272 DOI: 10.1111/nep.13980] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 12/24/2022]
Abstract
AIM To establish the responses to the Sinopharm HB02 COVID-19 vaccination in the dialysis population, which are not well established. We examined the humoral responses to the Sinopharm COVID vaccine in haemodialysis patients. METHODS Standard vaccinations (two doses at interval of ~21 days) were given to all consenting haemodialysis patients on dialysis (n = 1296). We measured the antibody responses at 14-21 days after the second vaccine to define the development of anti-spike antibodies >15 AU/ml after vaccination and observed the clinical effects of vaccination. RESULTS Vaccination was very well tolerated with few side-effects. In those who consented to antibody measurements, (n = 446) baseline sampling showed 77 had positive antibodies, yet received full vaccination without any apparent adverse events. Positive anti-spike antibodies developed in 50% of the 270 baseline negative patients who had full sampling, compared with 78.1% in the general population. COVID infection continues to occur in both vaccinated and unvaccinated individuals, but in the whole group vaccination appears to have been associated with a reduction in the case fatality rate. CONCLUSION The humoral immune responses to standard HB02 vaccination schedules are attenuated in a haemodialysis cohort, but likely the vaccine saves lives. We suggest that an enhanced HB02 vaccination course or antibody checking may be prudent to protect this vulnerable group of patients. We suggest a booster dose of this vaccine at 3 months should be given to all dialysis patients, on the grounds that it is well tolerated even in those with good antibody levels and there may be a survival advantage.
Collapse
Affiliation(s)
- Stephen Geoffrey Holt
- SEHA Kidney Care, SEHA-Abu Dhabi Health Services Company, Abu Dhabi, UAE.,Department of Medicine, Khalifa University, Abu Dhabi, UAE
| | | | - Wasim Ahmed
- SEHA Kidney Care, SEHA-Abu Dhabi Health Services Company, Abu Dhabi, UAE
| | - Juan Manuel Acuna
- SEHA Kidney Care, SEHA-Abu Dhabi Health Services Company, Abu Dhabi, UAE.,Department of Medicine, Khalifa University, Abu Dhabi, UAE
| | | | | | | | | | - Nawal Ahmed Al Kaabi
- Sheikh Khalifa Medical City, SEHA-Abu Dhabi Health Services Company, Abu Dhabi, UAE
| | - Ali Abdulkareem Al Obaidli
- SEHA Kidney Care, SEHA-Abu Dhabi Health Services Company, Abu Dhabi, UAE.,Department of Medicine, Khalifa University, Abu Dhabi, UAE
| |
Collapse
|
84
|
Windpessl M, Heine GH, Becker SL, Scheuer AL, Sester M, Kronbichler A. [The impact of immunosuppression and chronic kidney disease on immunogenicity of COVID-19 vaccines]. Dtsch Med Wochenschr 2021; 146:1277-1282. [PMID: 34553353 DOI: 10.1055/a-1550-7288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
HOW EFFECTIVE ARE THE APPROVED VACCINES IN KIDNEY DISEASES AND THOSE RECEIVING IMMUNOSUPPRESSION?: Several observational studies indicated that immunosuppression is associated with a weakened or absent humoral response. Patients with chronic kidney diseases or undergoing maintenance dialysis without immunosuppression have a reduced humoral response to COVID-19 vaccines. I HAD COVID-19. SHOULD I GET VACCINATED?: It is recommended to receive a booster after SARS-CoV-2 infection with a mRNA vaccine. IS A COVID-19 VACCINATION DESPITE ONGOING IMMUNOSUPPRESSION POSSIBLE?: Patients receiving immunosuppression have a reduced humoral response, and this is especially observed when anti-CD20 therapy is used. IS THERE A POSSIBILITY THAT THE VACCINE PROVOKES REJECTION OF MY TRANSPLANTED KIDNEY OR RELAPSE OF MY GLOMERULAR DISEASE?: Several reports were published in the last months highlighting new-onset diseases, recurrences and relapses of different glomerular diseases, which occurred after the receipt of the first or second vaccine dose. As a clear association of vaccines and induction of autoimmunity still needs to be established, most of these diseases are treatable, and COVID-19 in patients under immunosuppression is often fatal, there is a clear net benefit of vaccination. DO I HAVE A PERMANENT PROTECTION AFTER VACCINATION?: The antibody titers and likely the cellular immune response is significantly reduced in patients with kidney diseases, and titers are reducing at a fast pace under ongoing immunosuppression. A booster dose should be considered, especially taking into consideration the evolvement of virus variants and their impact on vaccine efficacy. AFTER THE FIRST SERIES OF VACCINATION, NO OR ONLY A MARGINAL AMOUNT OF ANTIBODIES WERE DETECTABLE. ARE THERE STRATEGIES TO IMPROVE VACCINE RESPONSE?: Many countries recommend the application of a third dose for vulnerable patient cohorts, especially because of a weakened response and their risk to develop a severe disease course of COVID-19. Prospective clinical trials are ongoing to test the ideal strategy to improve vaccine response in these cohorts.
Collapse
Affiliation(s)
- Martin Windpessl
- Innere Medizin IV, Klinikum Wels-Grieskirchen, Wels, Österreich.,Medizinische Fakultät, Kepler-Universitätsklinikum, Linz, Österreich
| | - Gunnar H Heine
- Medizinische Klinik II, AGAPLESION MARKUS-KRANKENHAUS, Frankfurt, Deutschland.,Universität des Saarlandes, Homburg, Deutschland
| | - Sören L Becker
- Institut für Medizinische Mikrobiologie und Hygiene, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - Anja L Scheuer
- Medizinische Klinik II, AGAPLESION MARKUS-KRANKENHAUS, Frankfurt, Deutschland.,Universität des Saarlandes, Homburg, Deutschland
| | - Martina Sester
- Abteilung für Transplantations- und Infektionsimmunologie, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | | |
Collapse
|
85
|
Dęborska-Materkowska D, Kamińska D. The Immunology of SARS-CoV-2 Infection and Vaccines in Solid Organ Transplant Recipients. Viruses 2021; 13:1879. [PMID: 34578460 PMCID: PMC8473113 DOI: 10.3390/v13091879] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/13/2021] [Accepted: 09/17/2021] [Indexed: 12/12/2022] Open
Abstract
Since its outbreak in December 2019, the coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), led to an enormous rise in scientific response with an excess of COVID-19-related studies on the pathogenesis and potential therapeutic approaches. Solid organ transplant (SOT) recipients are a heterogeneous population with long-lasting immunosuppression as a joining element. Immunocompromised patients are a vulnerable population with a high risk of severe infections and an increased infection-related mortality rate. It was postulated that the hyperinflammatory state due to cytokine release syndrome during severe COVID-19 could be alleviated by immunosuppressive therapy in SOT patients. On the other hand, it was previously established that T cell-mediated immunity, which is significantly weakened in SOT recipients, is the main component of antiviral immune responses. In this paper, we present the current state of science on COVID-19 immunology in relation to solid organ transplantation with prospective therapeutic and vaccination strategies in this population.
Collapse
Affiliation(s)
- Dominika Dęborska-Materkowska
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Nowogrodzka 59, 02-006 Warsaw, Poland;
| | - Dorota Kamińska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| |
Collapse
|
86
|
Carr EJ, Wu M, Harvey R, Wall EC, Kelly G, Hussain S, Howell M, Kassiotis G, Swanton C, Gandhi S, Bauer DL, Billany RE, Graham-Brown MP, Beckett J, Bull K, Shankar S, Henderson S, Motallebzadeh R, Salama AD, Harper L, Mark PB, McAdoo S, Willicombe M, Beale R. Neutralising antibodies after COVID-19 vaccination in UK haemodialysis patients. Lancet 2021; 398:1038-1041. [PMID: 34391504 PMCID: PMC8360704 DOI: 10.1016/s0140-6736(21)01854-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
| | - Mary Wu
- The Francis Crick Institute, London NW1 1AT, UK
| | - Ruth Harvey
- The Francis Crick Institute, London NW1 1AT, UK
| | - Emma C Wall
- The Francis Crick Institute, London NW1 1AT, UK
| | - Gavin Kelly
- The Francis Crick Institute, London NW1 1AT, UK
| | | | | | | | | | | | | | - Roseanne E Billany
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; Department of Renal Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK; NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Matthew Pm Graham-Brown
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; Department of Renal Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK; NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Joseph Beckett
- Transplantation Research & Immunology Group, University of Oxford, Oxford, UK
| | - Katherine Bull
- Nuffield Department of Surgical Sciences and Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sushma Shankar
- Transplantation Research & Immunology Group, University of Oxford, Oxford, UK; Oxford Transplant Centre, University of Oxford, Oxford, UK
| | - Scott Henderson
- UCL Department of Renal Medicine, Royal Free Hospital, London, UK
| | - Reza Motallebzadeh
- UCL Department of Renal Medicine, Royal Free Hospital, London, UK; Research Department of Surgical Biotechnology, Division of Surgery and Interventional Science, University College London, London, UK
| | - Alan D Salama
- UCL Department of Renal Medicine, Royal Free Hospital, London, UK
| | - Lorraine Harper
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Department of Nephrology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Patrick B Mark
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Stephen McAdoo
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Faculty of Medicine, Imperial College London, London UK; Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Michelle Willicombe
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Faculty of Medicine, Imperial College London, London UK; Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Rupert Beale
- The Francis Crick Institute, London NW1 1AT, UK; UCL Department of Renal Medicine, Royal Free Hospital, London, UK.
| |
Collapse
|
87
|
Update zu: Erfahrungen aus dem deutschen COVID-19-Register. DER NEPHROLOGE 2021; 16:311-313. [PMID: 34426749 PMCID: PMC8374112 DOI: 10.1007/s11560-021-00528-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 11/02/2022]
|
88
|
Hassani K, Errihani M, Mahamoud MH, ElKabbaj D. Membranoproliferative Glomerulonephritis following the Oxford AstraZeneca COVID-19 Vaccine. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2021; 32:1831-1832. [DOI: 10.4103/1319-2442.352451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|