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Charmetant X, Espi M, Barba T, Ovize A, Morelon E, Mathieu C, Thaunat O. Predictive factors of a viral neutralizing humoral response after a third dose of COVID-19 mRNA vaccine. Am J Transplant 2022; 22:1442-1450. [PMID: 35114060 PMCID: PMC10149236 DOI: 10.1111/ajt.16990] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 01/25/2023]
Abstract
Kidney transplant recipients (KTRs) have reduced ability to mount adequate antibody response after two doses of the COVID-19 mRNA vaccine. French health authorities have allowed a third booster dose (D3) for KTRs, but their response is heterogeneous and tools able to discriminate the responders are lacking. Anti-RBD IgG titers (chemiluminescence immunoassay), spike-specific cellular responses (IFN-γ-releasing assay, IGRA), and in vitro serum neutralization of the virus (the best available correlate of protection), were evaluated 7-14 days after the second dose (D2) of BNT162b2 vaccine in 93 KTRs. Among the 73 KTRs, whose serum did not neutralize SARS-CoV-2 in vitro after D2, 14 (19%) acquired this capacity after D3, and were considered as "responders." Exploratory univariate analysis identified short time from transplantation and high maintenance immunosuppression as detrimental factors for the response to D3. In addition, any of the presence of anti-RBD IgGs and/or positive IGRA after D2 was predictive of response to D3. By contrast, none of the KTRs with both a negative serology and IGRA responded to D3. In summary, routinely available bioassays performed after D2 allow identifying KTRs that will respond to a booster D3. These results pave the way for the personalization of vaccination strategy in KTRs.
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Affiliation(s)
- Xavier Charmetant
- CIRI, INSERM U1111, Université Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Univ. Lyon, Lyon, France
| | - Maxime Espi
- CIRI, INSERM U1111, Université Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Univ. Lyon, Lyon, France
| | - Thomas Barba
- CIRI, INSERM U1111, Université Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Univ. Lyon, Lyon, France
| | - Anne Ovize
- Eurofins Biomnis Laboratory, Lyon, France
| | - Emmanuel Morelon
- CIRI, INSERM U1111, Université Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Univ. Lyon, Lyon, France
- Department of Transplantation, Nephrology and Clinical Immunology, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
- Claude Bernard University (Lyon 1), Villeurbanne, France
| | - Cyrille Mathieu
- CIRI, INSERM U1111, Université Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Univ. Lyon, Lyon, France
| | - Olivier Thaunat
- CIRI, INSERM U1111, Université Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Univ. Lyon, Lyon, France
- Department of Transplantation, Nephrology and Clinical Immunology, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
- Claude Bernard University (Lyon 1), Villeurbanne, France
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52
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Fishman JA, Alter G. Humoral immune responses against SARS-CoV-2 in transplantation: Actionable biomarker or misplaced trust? Am J Transplant 2022; 22:1291-1292. [PMID: 35247296 PMCID: PMC9111200 DOI: 10.1111/ajt.17018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/01/2022] [Accepted: 03/01/2022] [Indexed: 01/25/2023]
Abstract
Measures of vaccine-specific antibodies to SARS-CoV-2, as discussed by Werbel and Segev (Page 1316), may ignore responses to contemporaneous variants of concern and relevant cellular immune responses, thereby failing to provide the insights required to optimize clinical care.
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Affiliation(s)
- Jay A. Fishman
- Transplant Infectious Disease and Compromised Host Program and Transplant Center, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA,Correspondence Jay A. Fishman, Transplant Infectious Disease and Compromised Host Program and Transplant Center, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.
| | - Galit Alter
- Ragon Institute, Cambridge, Massachusetts, USA,Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
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53
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Moreno NF, McAdams R, Goss JA, Galvan NTN. COVID-19 Vaccine Efficacy and Immunogenicity in End-Stage Renal Disease Patients and Kidney Transplant Recipients. CURRENT TRANSPLANTATION REPORTS 2022; 9:174-184. [PMID: 35506151 PMCID: PMC9051503 DOI: 10.1007/s40472-022-00366-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 01/06/2023]
Abstract
Purpose of Review To summarize the current literature with respect to COVID-19 vaccine efficacy patients with end-stage renal disease on dialysis and kidney transplant recipients. Recent Findings Immunosuppressed patients are at greater risk of morbidity and mortality from COVID-19 infection. Patients with ESRD and KTR are immunosuppressed and mount a weaker antibody response to COVID-19 mRNA vaccination, and factors including immunosuppressant medications have been implicated for this weakened response. Third and fourth doses of vaccine doses have been shown to increase seropositivity and antibody production in kidney transplant recipients and patients on dialysis. Retrospective studies have demonstrated decreased mortality in vaccinated, immunosuppressed patients. Summary ESRD and KTR patients have decreased antibody response to COVID-19 vaccines, but third and fourth doses have been shown to increase antibody production. Though a correlate of protection between antibody production and efficacy has yet to be fully established in this subset of the population, all US professional bodies who treat ESRD and KTR patients advocate for full vaccination against SARS-CoV-2 based on the data available. Studies demonstrating decreased mortality in vaccinated patients are promising on efficacy. Importantly, because KTR patients mount a weaker antibody response than ESRD patients, vaccination prior to kidney transplantation is critical.
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Affiliation(s)
- Nicolas F. Moreno
- McGovern Medical School, University of Texas Health Science Center, Houston, TX USA
| | - Robert McAdams
- McGovern Medical School, University of Texas Health Science Center, Houston, TX USA
| | - John A. Goss
- Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation, Baylor College of Medicine, Houston, TX USA
| | - N. Thao. N. Galvan
- Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation, Baylor College of Medicine, Houston, TX USA
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54
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Sutharattanapong N, Thotsiri S, Kantachuvesiri S, Wiwattanathum P. Benefits of Inactivated Vaccine and Viral Vector Vaccine Immunization on COVID-19 Infection in Kidney Transplant Recipients. Vaccines (Basel) 2022; 10:572. [PMID: 35455322 PMCID: PMC9031304 DOI: 10.3390/vaccines10040572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 12/01/2022] Open
Abstract
The coronavirus virus disease 2019 (COVID-19) pandemic has impacted the global healthcare system. In Thailand, the first and most available vaccines were inactivated and viral vector vaccines. We reported the impact of those vaccines in preventing severe disease and death in kidney transplant recipients. This retrospective study comprised 45 kidney transplant recipients with COVID-19 infection, classified by vaccination status. Outcomes of interest were death, pneumonia, and allograft dysfunction. There were 23 patients in vaccinated group and 22 patients in unvaccinated group. All baseline characteristics were similar except mean age was older in vaccinated group, 55 vs. 48 years. Total 11 patients (24%) died (13% vaccinated vs. 36% unvaccinated RR, 0.56; 95% CI, 0.29-0.83; p = 0.03). Multivariate analysis showed that vaccination significantly decrease mortality (odds ratio, 0.54; 95% CI, 0.10-0.94; p = 0.03). Pneumonia developed equally in both groups (70%). There was a trend toward less oxygen requirement as well as ventilator requirement in vaccinated group. The rate of allograft dysfunction was similar (47%). Inactivated and viral vector COVID-19 vaccines have beneficial effect on mortality reduction in kidney transplant recipients. Even partial vaccination can exert some protection against death. However, full vaccination should be encouraged to achieve better prevention.
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Affiliation(s)
- Napun Sutharattanapong
- Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Ratchathewi, Bangkok 10400, Thailand; (N.S.); (S.T.); (S.K.)
- Excellent Center for Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Sansanee Thotsiri
- Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Ratchathewi, Bangkok 10400, Thailand; (N.S.); (S.T.); (S.K.)
- Excellent Center for Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Surasak Kantachuvesiri
- Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Ratchathewi, Bangkok 10400, Thailand; (N.S.); (S.T.); (S.K.)
- Excellent Center for Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Punlop Wiwattanathum
- Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Ratchathewi, Bangkok 10400, Thailand; (N.S.); (S.T.); (S.K.)
- Excellent Center for Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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55
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Hamaya T, Hatakeyama S, Yoneyama T, Tobisawa Y, Kodama H, Fujita T, Murakami R, Fujita N, Okamoto T, Yamamoto H, Yoneyama T, Hashimoto Y, Saitoh H, Narumi S, Tomita H, Ohyama C. Seroprevalence of SARS-CoV-2 spike IgG antibodies after the second BNT162b2 mRNA vaccine in Japanese kidney transplant recipients. Sci Rep 2022; 12:5876. [PMID: 35393481 PMCID: PMC8988536 DOI: 10.1038/s41598-022-09897-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 03/11/2022] [Indexed: 12/21/2022] Open
Abstract
We aimed to evaluate the seroprevalence and investigated factors associated with seropositivity after the second SARS-CoV-2 mRNA vaccination in kidney transplant (KT) recipients. This retrospective study conducted between June and November 2021 included 106 KT recipients and 127 healthy controls who received the second dose of the BNT162b2 mRNA vaccine at least 7 days before the measurement of antibody titers. The antibody titer against the receptor-binding domain of SARS-CoV-2 spike (S) protein was determined. We compared seroprevalence rates (immunoglobulin G [IgG] level of ≥ 0.8 or ≥ 15 U/mL) between the healthy controls and KT recipients and identified factors associated with impaired humoral response. The seroprevalence rate of the healthy controls and KT recipients was 98% and 22%, respectively. Univariate logistic regression analysis revealed that age > 53 years, rituximab use, mycophenolate mofetil use, and KT vintage < 7 years were negatively associated with the rate of anti-SARS-CoV-2 S IgG ≥ 15 U/mL in KT recipients. ABO blood type incompatible KT was not significantly associated with seroprevalence. Humoral response after the second BNT162b2 mRNA vaccine was greatly hindered by immunosuppression therapy in KT recipients. Older age, rituximab use, mycophenolate mofetil use, and KT vintage may play key roles in seroconversion.
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Affiliation(s)
- Tomoko Hamaya
- Department of Urology, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Shingo Hatakeyama
- Department of Advanced Blood Purification Therapy, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
| | - Tohru Yoneyama
- Department of Glycotechnology, Center for Advanced Medical Research, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Yuki Tobisawa
- Department of Urology, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Hirotake Kodama
- Department of Urology, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Takeshi Fujita
- Department of Cardiology and Nephrology, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Reiichi Murakami
- Department of Cardiology and Nephrology, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Naoki Fujita
- Department of Urology, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Teppei Okamoto
- Department of Urology, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Takahiro Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Yasuhiro Hashimoto
- Department of Urology, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Hisao Saitoh
- Department of Urology, Oyokyo Kidney Research Institute, 90 Kozawayamazaki, Hirosaki, Aomori, 036-8243, Japan
| | - Shunji Narumi
- Department of Transplant Nephrology and Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Hirofumi Tomita
- Department of Cardiology and Nephrology, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
- Department of Advanced Blood Purification Therapy, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
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56
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Ma BM, Tam AR, Chan KW, Ma MKM, Hung IFN, Yap DYH, Chan TM. Immunogenicity and Safety of COVID-19 Vaccines in Patients Receiving Renal Replacement Therapy: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:827859. [PMID: 35355604 PMCID: PMC8959490 DOI: 10.3389/fmed.2022.827859] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/09/2022] [Indexed: 01/11/2023] Open
Abstract
Background Systematic data on the efficacy and safety of COVID-19 vaccine in patients on renal replacement therapy (RRT) remains limited. We conducted a meta-analysis on the efficacy and safety of COVID-19 vaccine in patients on RRT. Methods Eligible studies were identified by systematic literature search in four electronic databases. Twenty-seven studies (4,264 patients) were included for meta-analysis. 99% patients received mRNA vaccine. Results Patients on RRT showed inferior seropositivity after two-dosed COVID-19 vaccine, 44% lower than the general population. Kidney transplant recipients (KTRs) had significantly lower seropositivity than patients on haemodialysis (HD) or peritoneal dialysis (PD) (26.1 vs. 84.3% and 92.4% respectively, p < 0.001 for both). Compared with healthy controls, KTRs, HD and PD patients were 80% (95% CI: 62–99%), 18% (95% CI: 9–27%) and 11% (95% CI: 1–21%) less likely to develop antibodies after vaccination (p < 0.001, <0.001 and 0.39 respectively). In KTRs, every 1% increase in using mycophenolate was associated with 0.92% reduction in seropositivity (95% CI: −1.68, −0.17, p = 0.021) at population level. The overall adverse event rate attributed to vaccination was 2.1%. Most events were mild. Conclusion Patients on RRT, particularly KTRs, had significantly reduced antibody response after two-dosed COVID-19 vaccination. Vaccination is generally well tolerated. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42021261879.
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Affiliation(s)
- Becky Mingyao Ma
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Anthony Raymond Tam
- Division of Infectious Diseases, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Kam Wa Chan
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Maggie Kam Man Ma
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Ivan Fan Ngai Hung
- Division of Infectious Diseases, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Desmond Yat Hin Yap
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Tak Mao Chan
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Manothummetha K, Chuleerarux N, Sanguankeo A, Kates OS, Hirankarn N, Thongkam A, Dioverti-Prono MV, Torvorapanit P, Langsiri N, Worasilchai N, Moonla C, Plongla R, Garneau WM, Chindamporn A, Nissaisorakarn P, Thaniyavarn T, Nematollahi S, Permpalung N. Immunogenicity and Risk Factors Associated With Poor Humoral Immune Response of SARS-CoV-2 Vaccines in Recipients of Solid Organ Transplant: A Systematic Review and Meta-Analysis. JAMA Netw Open 2022; 5:e226822. [PMID: 35412626 PMCID: PMC9006106 DOI: 10.1001/jamanetworkopen.2022.6822] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Recipients of solid organ transplant (SOT) experience decreased immunogenicity after COVID-19 vaccination. OBJECTIVE To summarize current evidence on vaccine responses and identify risk factors for diminished humoral immune response in recipients of SOT. DATA SOURCES A literature search was conducted from existence of database through December 15, 2021, using MEDLINE, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov. STUDY SELECTION Studies reporting humoral immune response of the COVID-19 vaccines in recipients of SOT were reviewed. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data from each eligible study. Descriptive statistics and a random-effects model were used. This report was prepared following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Data were analyzed from December 2021 to February 2022. MAIN OUTCOMES AND MEASURES The total numbers of positive immune responses and percentage across each vaccine platform were recorded. Pooled odds ratios (pORs) with 95% CIs were used to calculate the pooled effect estimates of risk factors for poor antibody response. RESULTS A total of 83 studies were included for the systematic review, and 29 studies were included in the meta-analysis, representing 11 713 recipients of SOT. The weighted mean (range) of total positive humoral response for antispike antibodies after receipt of mRNA COVID-19 vaccine was 10.4% (0%-37.9%) for 1 dose, 44.9% (0%-79.1%) for 2 doses, and 63.1% (49.1%-69.1%) for 3 doses. In 2 studies, 50% of recipients of SOT with no or minimal antibody response after 3 doses of mRNA COVID-19 vaccine mounted an antibody response after a fourth dose. Among the factors associated with poor antibody response were older age (mean [SE] age difference between responders and nonresponders, 3.94 [1.1] years), deceased donor status (pOR, 0.66 [95% CI, 0.53-0.83]; I2 = 0%), antimetabolite use (pOR, 0.21 [95% CI, 0.14-0.29]; I2 = 70%), recent rituximab exposure (pOR, 0.21 [95% CI, 0.07-0.61]; I2 = 0%), and recent antithymocyte globulin exposure (pOR, 0.32 [95% CI, 0.15-0.71]; I2 = 0%). CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis, the rates of positive antibody response in solid organ transplant recipients remained low despite multiple doses of mRNA vaccines. These findings suggest that more efforts are needed to modulate the risk factors associated with reduced humoral responses and to study monoclonal antibody prophylaxis among recipients of SOT who are at high risk of diminished humoral response.
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Affiliation(s)
- Kasama Manothummetha
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nipat Chuleerarux
- Department of Physiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Anawin Sanguankeo
- Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Olivia S. Kates
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nattiya Hirankarn
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Achitpol Thongkam
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Pattama Torvorapanit
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Nattapong Langsiri
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Chatphatai Moonla
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Rongpong Plongla
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - William M Garneau
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ariya Chindamporn
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Tany Thaniyavarn
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Saman Nematollahi
- Department of Medicine, University of Arizona College of Medicine, Tucson
| | - Nitipong Permpalung
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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58
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Bemben NM, Berg ML. Efficacy of inactivated vaccines in patients treated with immunosuppressive drug therapy. Pharmacotherapy 2022; 42:334-342. [PMID: 35146780 PMCID: PMC9088666 DOI: 10.1002/phar.2671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 12/17/2022]
Affiliation(s)
- Nina M. Bemben
- Wolters Kluwer Clinical Effectiveness Chicago Illinois USA
| | - Melody L. Berg
- American Society of Health‐System Pharmacists Bethesda Maryland USA
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Zhang R, Shin B, Gadsden TM, Petrosyan A, Vo A, Ammerman N, Sethi S, Huang E, Peng A, Najjar R, Atienza J, Kim I, Jordan SC. Assessment of humoral and cellular immune responses to SARS CoV-2 vaccination (BNT162b2) in immunocompromised renal allograft recipients. Transpl Infect Dis 2022; 24:e13813. [PMID: 35202497 PMCID: PMC9115352 DOI: 10.1111/tid.13813] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/14/2022] [Accepted: 02/04/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Assessing the composition of immune responses to SARS-CoV-2 vaccines is critical for our understanding of protective immunity, especially for immune compromised patients. The Pfizer (BNT162b2) vaccination showed >90% efficacy in protecting individuals from infection. However, these studies did not examine responses in immunocompromised kidney transplant patients (KT). Subsequent reports in KT have shown severe deficiencies in Spike-specific immunoglobin G (IgG) responses prompting booster vaccinations, but a broader understanding of T-cell immunity to vaccinating is lacking. METHODS We examined SARS-CoV-2 Spike IgG and CD4+/CD8+ Spike-specific T-cell responses in 61 KT patients maintained on different immunosuppressive protocols (ISP) (Tac + mycophenolate mofetil + prednisone) versus (belatacept + MMF + prednisone) and compared to 41 healthy controls. We also examined cytomegalovirus-cytotoxic T-cell responses (CMV-Tc) in both groups to assess T-cell memory. RESULTS Our data confirmed poor Spike IgG responses in vaccinated KT patients with both ISP (21% demonstrating Spike IgG 1M post-second dose of BNT162b2 vs. 93% in controls). However, 35% of Spike IgG (-) patients demonstrated CD4+ and/or CD8+ T-cell responses. All but one CMV-IgG+ patient demonstrated good CMV-Tc responses. No differences in T-cell immunity by ISP were seen. CONCLUSION Immunocompromised KT recipients showed severe defects in humoral and T-cell immune response after vaccination. No differences in immune responses to SARS-CoV-2 Spike peptides were observed in KT patients by ISP post-vaccination. The detection of Spike-specific T-cell immunity in the absence of Spike IgG suggests that vaccination in immunocompromised KT patients may provide partial immunity, although not preventing infection, T-cell immunity may limit its severity.
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Affiliation(s)
- Ruan Zhang
- Comprehensive Transplant CenterTransplant Immunology LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Bong‐Ha Shin
- Comprehensive Transplant CenterTransplant Immunology LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Terry‐Ann M. Gadsden
- Comprehensive Transplant CenterTransplant Immunology LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Anna Petrosyan
- Comprehensive Transplant CenterTransplant Immunology LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Ashley Vo
- Comprehensive Transplant CenterTransplant Immunology LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Noriko Ammerman
- Comprehensive Transplant CenterTransplant Immunology LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Supreet Sethi
- Comprehensive Transplant CenterTransplant Immunology LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Edmund Huang
- Comprehensive Transplant CenterTransplant Immunology LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Alice Peng
- Comprehensive Transplant CenterTransplant Immunology LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Reiad Najjar
- Comprehensive Transplant CenterTransplant Immunology LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Janet Atienza
- Comprehensive Transplant CenterTransplant Immunology LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Irene Kim
- Comprehensive Transplant CenterTransplant Immunology LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Stanley C. Jordan
- Comprehensive Transplant CenterTransplant Immunology LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
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Sanders JSF, Bemelman FJ, Messchendorp AL, Baan CC, van Baarle D, van Binnendijk R, Diavatopoulos DA, Frölke SC, Geers D, GeurtsvanKessel CH, den Hartog G, van der Heiden M, Imhof C, Kho MM, Koopmans MP, Malahe SRK, Mattheussens WB, van der Molen R, van Mourik D, Remmerswaal EB, Rots N, Vart P, de Vries RD, Gansevoort RT, Hilbrands LB, Reinders ME. The RECOVAC Immune-response Study: The Immunogenicity, Tolerability, and Safety of COVID-19 Vaccination in Patients With Chronic Kidney Disease, on Dialysis, or Living With a Kidney Transplant. Transplantation 2022; 106:821-834. [PMID: 34753894 PMCID: PMC8942603 DOI: 10.1097/tp.0000000000003983] [Citation(s) in RCA: 120] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/22/2021] [Accepted: 09/26/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND In kidney patients COVID-19 is associated with severely increased morbidity and mortality. A comprehensive comparison of the immunogenicity, tolerability, and safety of COVID-19 vaccination in different cohorts of kidney patients and a control cohort is lacking. METHODS This investigator driven, prospective, controlled multicenter study included 162 participants with chronic kidney disease (CKD) stages G4/5 (eGFR < 30 mL/min/1.73m2), 159 participants on dialysis, 288 kidney transplant recipients, and 191 controls. Participants received 2 doses of the mRNA-1273 COVID-19 vaccine (Moderna). The primary endpoint was seroconversion. RESULTS Transplant recipients had a significantly lower seroconversion rate when compared with controls (56.9% versus 100%, P < 0.001), with especially mycophenolic acid, but also, higher age, lower lymphocyte concentration, lower eGFR, and shorter time after transplantation being associated with nonresponder state. Transplant recipients also showed significantly lower titers of neutralizing antibodies and T-cell responses when compared with controls. Although a high seroconversion rate was observed for participants with CKD G4/5 (100%) and on dialysis (99.4%), mean antibody concentrations in the CKD G4/5 cohort and dialysis cohort were lower than in controls (2405 [interquartile interval 1287-4524] and 1650 [698-3024] versus 3186 [1896-4911] BAU/mL, P = 0.06 and P < 0.001, respectively). Dialysis patients and especially kidney transplant recipients experienced less systemic vaccination related adverse events. No specific safety issues were noted. CONCLUSIONS The immune response following vaccination in patients with CKD G4/5 and on dialysis is almost comparable to controls. In contrast, kidney transplant recipients have a poor response. In this latter, patient group development of alternative vaccination strategies are warranted.
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Affiliation(s)
- Jan-Stephan F. Sanders
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frederike J. Bemelman
- Renal Transplant Unit, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A. Lianne Messchendorp
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Carla C. Baan
- Department of Internal Medicine, Nephrology, and Transplantation, Erasmus MC Transplant Institute, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Debbie van Baarle
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Groningen, The Netherlands
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Rob van Binnendijk
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Dimitri A. Diavatopoulos
- Radboud Center for Infectious Diseases, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
- Radboud Institute for Molecular Life Sciences, Department of Laboratory Medicine, Laboratory of Medical Immunology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Sophie C. Frölke
- Renal Transplant Unit, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Daryl Geers
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Gerco den Hartog
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Marieke van der Heiden
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Groningen, The Netherlands
| | - Celine Imhof
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Groningen, The Netherlands
| | - Marcia M.L. Kho
- Department of Internal Medicine, Nephrology, and Transplantation, Erasmus MC Transplant Institute, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | - Wouter B. Mattheussens
- Department of Nephrology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Renate van der Molen
- Radboud Institute for Molecular Life Sciences, Department of Laboratory Medicine, Laboratory of Medical Immunology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Djenolan van Mourik
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ester B.M. Remmerswaal
- Department of Experimental Immunology, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Nynke Rots
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Priya Vart
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rory D. de Vries
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ron T. Gansevoort
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Luuk B. Hilbrands
- Department of Nephrology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Marlies E.J. Reinders
- Department of Internal Medicine, Nephrology, and Transplantation, Erasmus MC Transplant Institute, Erasmus Medical Center, Rotterdam, The Netherlands
| | - RECOVAC Collaborators*
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Renal Transplant Unit, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Nephrology, and Transplantation, Erasmus MC Transplant Institute, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Groningen, The Netherlands
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Radboud Center for Infectious Diseases, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
- Radboud Institute for Molecular Life Sciences, Department of Laboratory Medicine, Laboratory of Medical Immunology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Nephrology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Department of Experimental Immunology, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Wünsch K, Anastasiou OE, Alt M, Brochhagen L, Cherneha M, Thümmler L, van Baal L, Madel RJ, Lindemann M, Taube C, Witzke O, Rohn H, Krawczyk A, Jansen S. COVID-19 in Elderly, Immunocompromised or Diabetic Patients—From Immune Monitoring to Clinical Management in the Hospital. Viruses 2022; 14:v14040746. [PMID: 35458476 PMCID: PMC9024512 DOI: 10.3390/v14040746] [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: 02/27/2022] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 01/01/2023] Open
Abstract
The novel, highly transmissible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has triggered a pandemic of acute respiratory illness worldwide and remains a huge threat to the healthcare system’s capacity to respond to COVID-19. Elderly and immunocompromised patients are at increased risk for a severe course of COVID-19. These high-risk groups have been identified as developing diminished humoral and cellular immune responses. Notably, SARS-CoV-2 RNA remains detectable in nasopharyngeal swabs of these patients for a prolonged period of time. These factors complicate the clinical management of these vulnerable patient groups. To date, there are no well-defined guidelines for an appropriate duration of isolation for elderly and immunocompromised patients, especially in hospitals or nursing homes. The aim of the present study was to characterize at-risk patient cohorts capable of producing a replication-competent virus over an extended period after symptomatic COVID-19, and to investigate the humoral and cellular immune responses and infectivity to provide a better basis for future clinical management. In our cohort, the rate of positive viral cultures and the sensitivity of SARS-CoV-2 antigen tests correlated with higher viral loads. Elderly patients and patients with diabetes mellitus had adequate cellular and humoral immune responses to SARS-CoV-2 infection, while immunocompromised patients had reduced humoral and cellular immune responses. Our patient cohort was hospitalized for longer compared with previously published cohorts. Longer hospitalization was associated with a high number of nosocomial infections, representing a potential hazard for additional complications to patients. Most importantly, regardless of positive SARS-CoV-2 RNA detection, no virus was culturable beyond a cycle threshold (ct) value of 33 in the majority of samples. Our data clearly indicate that elderly and diabetic patients develop a robust immune response to SARS-CoV-2 and may be safely de-isolated at a ct value of more than 35.
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Affiliation(s)
- Korbinian Wünsch
- West German Centre of Infectious Diseases, Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany; (K.W.); (M.A.); (L.B.); (M.C.); (L.T.); (R.J.M.); (O.W.); (A.K.)
| | - Olympia E. Anastasiou
- Institute for Virology, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany;
| | - Mira Alt
- West German Centre of Infectious Diseases, Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany; (K.W.); (M.A.); (L.B.); (M.C.); (L.T.); (R.J.M.); (O.W.); (A.K.)
| | - Leonie Brochhagen
- West German Centre of Infectious Diseases, Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany; (K.W.); (M.A.); (L.B.); (M.C.); (L.T.); (R.J.M.); (O.W.); (A.K.)
| | - Maxim Cherneha
- West German Centre of Infectious Diseases, Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany; (K.W.); (M.A.); (L.B.); (M.C.); (L.T.); (R.J.M.); (O.W.); (A.K.)
| | - Laura Thümmler
- West German Centre of Infectious Diseases, Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany; (K.W.); (M.A.); (L.B.); (M.C.); (L.T.); (R.J.M.); (O.W.); (A.K.)
- Institute for Transfusion Medicine, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany;
| | - Lukas van Baal
- Department of Endocrinology, Diabetes and Metabolism and Division of Laboratory Research, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany;
| | - Rabea J. Madel
- West German Centre of Infectious Diseases, Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany; (K.W.); (M.A.); (L.B.); (M.C.); (L.T.); (R.J.M.); (O.W.); (A.K.)
| | - Monika Lindemann
- Institute for Transfusion Medicine, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany;
| | - Christian Taube
- Department of Pneumology, University Medicine Essen—Ruhrlandklinik, University Duisburg-Essen, 45147 Essen, Germany;
| | - Oliver Witzke
- West German Centre of Infectious Diseases, Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany; (K.W.); (M.A.); (L.B.); (M.C.); (L.T.); (R.J.M.); (O.W.); (A.K.)
| | - Hana Rohn
- West German Centre of Infectious Diseases, Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany; (K.W.); (M.A.); (L.B.); (M.C.); (L.T.); (R.J.M.); (O.W.); (A.K.)
- Correspondence: (H.R.); (S.J.)
| | - Adalbert Krawczyk
- West German Centre of Infectious Diseases, Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany; (K.W.); (M.A.); (L.B.); (M.C.); (L.T.); (R.J.M.); (O.W.); (A.K.)
| | - Sarah Jansen
- West German Centre of Infectious Diseases, Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany; (K.W.); (M.A.); (L.B.); (M.C.); (L.T.); (R.J.M.); (O.W.); (A.K.)
- Correspondence: (H.R.); (S.J.)
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Togashi K, Hatakeyama S, Yoneyama T, Hamaya T, Narita T, Fujita N, Iwamura H, Okamoto T, Yamamoto H, Yoneyama T, Hashimoto Y, Ohyama C. Effect of active anticancer therapy on serologic response to SARS-CoV-2 BNT162b2 vaccine in patients with urothelial and renal cell carcinoma. Int J Urol 2022; 29:733-739. [PMID: 35362143 PMCID: PMC9111834 DOI: 10.1111/iju.14882] [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: 12/02/2021] [Accepted: 03/21/2022] [Indexed: 12/20/2022]
Abstract
Objectives To evaluate the serologic response to the BNT162b2 messenger ribonucleic acid vaccine in patients with urothelial carcinoma and renal cell carcinoma. Methods Between June 2021 and November 2021, we retrospectively evaluated blood samples from 60 healthy controls (control group), 57 patients with urothelial carcinoma, and 28 patients with renal cell carcinoma who had received two doses of the BNT162b2 vaccine at Hirosaki University Hospital. We determined the immunoglobulin G antibody titers against the severe acute respiratory syndrome coronavirus 2 spike receptor‐binding domain. Seropositivity was defined as ≥15 U/mL. We investigate factors associated with antibody titers and seropositivity in the patients with urothelial carcinoma and renal cell carcinoma. Results Antibody titers in the control, urothelial carcinoma, and renal cell carcinoma groups were 813, 431, and 500 U/mL, respectively. Seropositivity was 100%, 90%, and 96% in the control, urothelial carcinoma, and renal cell carcinoma groups, respectively. Of the 85 patients, 37 of 57 (65%) and 21 of 28 (75%) were actively undergoing anticancer treatment for urothelial carcinoma and renal cell carcinoma, respectively. Anti‐severe acute respiratory syndrome coronavirus 2 spike immunoglobulin G antibody titers and seropositivity was not significantly different between the patients with urothelial carcinoma and renal cell carcinoma. Anti‐severe acute respiratory syndrome coronavirus 2 spike immunoglobulin G antibody titers were not significantly associated with active anticancer therapy or steroid treatment for immune‐related adverse events. Univariable logistic regression analysis revealed that older age and metastatic disease were significantly and negatively associated with seropositivity. Conclusions Patients with urothelial carcinoma or renal cell carcinoma exhibited an adequate antibody response to the BNT162b2 vaccine. Active anticancer therapy was not significantly associated with seropositivity following vaccination with severe acute respiratory syndrome coronavirus 2 BNT162b2 in patients with urothelial carcinoma and renal cell carcinoma.
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Affiliation(s)
- Kyo Togashi
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
| | - Shingo Hatakeyama
- Department of Advanced Blood Purification Therapy, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
| | - Tohru Yoneyama
- Department of Glycotechnology, Center for Advanced Medical Research, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
| | - Tomoko Hamaya
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
| | - Takuma Narita
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
| | - Naoki Fujita
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
| | - Hiromichi Iwamura
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
| | - Teppei Okamoto
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
| | - Takahiro Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
| | - Yasuhiro Hashimoto
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan.,Department of Advanced Blood Purification Therapy, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan.,Department of Glycotechnology, Center for Advanced Medical Research, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
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63
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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.
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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
| | - 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
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Jasuja S, Jha V, Sagar G, Bahl A, Verma S, Jasuja N, Kaur J. Post vaccination analysis of anti-spike antibody responses in kidney transplant recipients with and without COVID-19 infection in a tertiary care center, India. Clin Kidney J 2022; 15:1312-1321. [PMID: 35747093 PMCID: PMC8903484 DOI: 10.1093/ckj/sfac057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
To investigate the anti-spike antibody response to vaccination in Kidney transplant recipients (KTRs) previously infected with SARS-CoV-2 as compared to KTRs with no history of COVID-19 from India.
Methods
SARS-CoV-2 spike immunoglobulin (Ig) G antibody response was measured in 105 post COVID-19 KTRs with PCR confirmed SARS-CoV-2 infection who received either no vaccination (cohort 1), single (cohort 2) or two doses (cohort 3) of vaccine and compared to 103 two-dose vaccinated COVID-19 naïve KTRs with no history of COVID-19 (cohort 4).
Results
Out of 103 COVID-19 naïve two-dose vaccinated KTRs, less than 50% became seropositive with anti-spike antibody titres > 50AU/mL subsequent to complete vaccination, the seroconversion rate being comparable in subjects receiving CovishieldTM versus CovaxinTM vaccines. However, the seropositive KTRs vaccinated with CovishieldTM had higher anti-spike antibody titres as compared to those who received CovaxinTM. We observed higher anti-SARS-CoV-2 spike antibody levels in post COVID-19 KTRs after 1 dose of vaccine as compared with COVID-19 naïve two-dose vaccinated KTRs. Importantly, the second dose in post COVID-19 KTRs did not significantly increase anti-spike antibody levels compared with the single dose recipients.
Conclusions
Our data presents that in KTRs with previous SARS-CoV-2 infection a single dose of vaccine (CovishieldTM) may be effective in mounting optimal immune response. In contrast, COVID-19 naïve two-dose vaccinated KTRs respond poorly (<50%) to current recommendation of a two-dose regimen in India.
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Affiliation(s)
- Sanjiv Jasuja
- Indraprastha Apollo Hospital, Department Of Nephrology, New Delhi, India
| | - Vivekanand Jha
- George Institute for Global Health, UNSW, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Gaurav Sagar
- Indraprastha Apollo Hospital, Department Of Nephrology, New Delhi, India
| | - Anupam Bahl
- Indraprastha Apollo Hospital, Department Of Nephrology, New Delhi, India
| | - Shalini Verma
- AVATAR Foundation, Department of Clinical Research, New Delhi, India
| | - Neharita Jasuja
- AVATAR Foundation, Department of Clinical Research, New Delhi, India
| | - Jasmeet Kaur
- Dr Lal PathLabs Ltd, National Reference Laboratory, Department of Histocompatibility and Transplant Immunology, New Delhi, India
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65
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Lee ARYB, Wong SY, Chai LYA, Lee SC, Lee MX, Muthiah MD, Tay SH, Teo CB, Tan BKJ, Chan YH, Sundar R, Soon YY. Efficacy of covid-19 vaccines in immunocompromised patients: systematic review and meta-analysis. BMJ 2022; 376:e068632. [PMID: 35236664 PMCID: PMC8889026 DOI: 10.1136/bmj-2021-068632] [Citation(s) in RCA: 223] [Impact Index Per Article: 111.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To compare the efficacy of covid-19 vaccines between immunocompromised and immunocompetent people. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Embase, Central Register of Controlled Trials, COVID-19 Open Research Dataset Challenge (CORD-19), and WHO covid-19 databases for studies published between 1 December 2020 and 5 November 2021. ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform were searched in November 2021 to identify registered but as yet unpublished or ongoing studies. STUDY SELECTION Prospective observational studies comparing the efficacy of covid-19 vaccination in immunocompromised and immunocompetent participants. METHODS A frequentist random effects meta-analysis was used to separately pool relative and absolute risks of seroconversion after the first and second doses of a covid-19 vaccine. Systematic review without meta-analysis of SARS-CoV-2 antibody titre levels was performed after first, second, and third vaccine doses and the seroconversion rate after a third dose. Risk of bias and certainty of evidence were assessed. RESULTS 82 studies were included in the meta-analysis. Of these studies, 77 (94%) used mRNA vaccines, 16 (20%) viral vector vaccines, and 4 (5%) inactivated whole virus vaccines. 63 studies were assessed to be at low risk of bias and 19 at moderate risk of bias. After one vaccine dose, seroconversion was about half as likely in patients with haematological cancers (risk ratio 0.40, 95% confidence interval 0.32 to 0.50, I2=80%; absolute risk 0.29, 95% confidence interval 0.20 to 0.40, I2=89%), immune mediated inflammatory disorders (0.53, 0.39 to 0.71, I2=89%; 0.29, 0.11 to 0.58, I2=97%), and solid cancers (0.55, 0.46 to 0.65, I2=78%; 0.44, 0.36 to 0.53, I2=84%) compared with immunocompetent controls, whereas organ transplant recipients were 16 times less likely to seroconvert (0.06, 0.04 to 0.09, I2=0%; 0.06, 0.04 to 0.08, I2=0%). After a second dose, seroconversion remained least likely in transplant recipients (0.39, 0.32 to 0.46, I2=92%; 0.35, 0.26 to 0.46), with only a third achieving seroconversion. Seroconversion was increasingly likely in patients with haematological cancers (0.63, 0.57 to 0.69, I2=88%; 0.62, 0.54 to 0.70, I2=90%), immune mediated inflammatory disorders (0.75, 0.69 to 0.82, I2=92%; 0.77, 0.66 to 0.85, I2=93%), and solid cancers (0.90, 0.88 to 0.93, I2=51%; 0.89, 0.86 to 0.91, I2=49%). Seroconversion was similar between people with HIV and immunocompetent controls (1.00, 0.98 to 1.01, I2=0%; 0.97, 0.83 to 1.00, I2=89%). Systematic review of 11 studies showed that a third dose of a covid-19 mRNA vaccine was associated with seroconversion among vaccine non-responders with solid cancers, haematological cancers, and immune mediated inflammatory disorders, although response was variable in transplant recipients and inadequately studied in people with HIV and those receiving non-mRNA vaccines. CONCLUSION Seroconversion rates after covid-19 vaccination were significantly lower in immunocompromised patients, especially organ transplant recipients. A second dose was associated with consistently improved seroconversion across all patient groups, albeit at a lower magnitude for organ transplant recipients. Targeted interventions for immunocompromised patients, including a third (booster) dose, should be performed. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021272088.
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Affiliation(s)
| | - Shi Yin Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Louis Yi Ann Chai
- Division of Infectious Diseases, Department of Medicine, National University Health System, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Synthetic Biology for Clinical and Technological Innovation, National University of Singapore, Singapore
- National University Cancer Institute, Singapore
| | - Soo Chin Lee
- Department of Haematology-Oncology, National University Cancer Institute, National University Hospital, 119228, Singapore
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Matilda Xinwei Lee
- Department of Haematology-Oncology, National University Cancer Institute, National University Hospital, 119228, Singapore
| | - Mark Dhinesh Muthiah
- Department of Gastroenterology and Hepatology, National University Health System, Singapore
- National University Centre for Organ Transplantation, Singapore
| | - Sen Hee Tay
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore
| | - Chong Boon Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Raghav Sundar
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Haematology-Oncology, National University Cancer Institute, National University Hospital, 119228, Singapore
- Cancer and Stem Cell Biology Program, Duke-NUS Medical School, Singapore
- The N.1 Institute for Health, National University of Singapore, Singapore
- Singapore Gastric Cancer Consortium, Singapore
| | - Yu Yang Soon
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Radiation Oncology, National University Cancer Institute, Singapore
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Crespo M, Barrilado-Jackson A, Padilla E, Eguía J, Echeverria-Esnal D, Cao H, Faura A, Folgueiras M, Solà-Porta E, Pascual S, Barbosa F, Hurtado S, Ribera L, Río-No L, Pérez-Sáez MJ, Redondo-Pachón D, Pascual J. Negative immune responses to two-dose mRNA COVID-19 vaccines in renal allograft recipients assessed with simple antibody and interferon gamma release assay cellular monitoring. Am J Transplant 2022; 22:786-800. [PMID: 34551187 PMCID: PMC8653097 DOI: 10.1111/ajt.16854] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 01/25/2023]
Abstract
Studies are urgently needed to characterize immunogenicity, efficacy, and safety of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccines in kidney transplant (KT) recipients, excluded from major clinical trials. Complex ELISPOT and other cellular response techniques have been applied, but simpler tools are needed. An easy-to-use real-world monitoring of SARS-CoV-2 IgG antibodies against the Spike protein and QuantiFERON® SARS-CoV-2 IFNγ release assay (IGRA) were performed at baseline and 28 days after the second dose in KT recipients and controls (dialysis patients and healthy ones). All healthy controls and >95% dialysis controls became positive for anti-S IgG antibodies, while only 63.3% of KT patients seroconverted with a very low antibody level. A positive IGRA was documented in 96.9% of controls, 89.3% peritoneal dialysis, 77.6% hemodialysis, 61.3% of KT patients transplanted more than 1 year ago and only 36% of those transplanted within the previous 12 months. Overall, 100% of healthy controls, 95.4% of dialysis patients and 78.8% KT recipients developed any immune response (humoral and/or cellular) against SARS-CoV-2. KT patients showed low rates of immune responses to mRNA Coronavirus infectious disease 2019 vaccines, especially those with recent transplantations. Simple humoral and cellular monitoring is advisable, so that repeated doses may be scheduled according to the results.
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Affiliation(s)
- Marta Crespo
- Department of Nephrology, Hospital del Mar, Barcelona, Spain,Correspondence Marta Crespo, Department of Nephrology, Hospital del Mar, Barcelona, Spain.
| | | | | | - Jorge Eguía
- Laboratori de Referència de Catalunya SA, Barcelona, Spain
| | - Daniel Echeverria-Esnal
- Pharmacy Department, Hospital del Mar, Barcelona, Spain,Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar for Medical Research, Barcelona, Spain
| | - Higini Cao
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Anna Faura
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | | | | | - Sergi Pascual
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | | | - Sara Hurtado
- Department of Nephrology, Fresenius Medical Care Services, Barcelona, Spain
| | - Laura Ribera
- Department of Nephrology, Fresenius Medical Care Services, Barcelona, Spain
| | - Laura Río-No
- Pharmacy Department, Hospital del Mar, Barcelona, Spain
| | | | | | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Barcelona, Spain,Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
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Vaccine breakthrough infections in veterans hospitalized with coronavirus infectious disease-2019: A case series. Am J Infect Control 2022; 50:273-276. [PMID: 34653528 PMCID: PMC8511894 DOI: 10.1016/j.ajic.2021.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/01/2021] [Accepted: 10/02/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND While Severe Acute Respiratory Syndrome Coronavirus-2 vaccine breakthrough infections are expected, reporting on breakthrough infections requiring hospitalization remains limited. This observational case series report reviewed 10 individuals hospitalized with vaccine breakthrough infections to identify patient risk factors and serologic responses upon admission. METHODS Electronic medical records of BNT162b2 (Pfizer-BioNTech) or mRNA-1732 (Moderna) vaccinated patients admitted to Veterans Affairs Ann Arbor Healthcare System with newly diagnosed Coronavirus Infectious Disease 2019 (COVID-19) between March 15, 2021 and April 15, 2021 were reviewed. Patient variables, COVID-19 lab testing including anti-S IgM, anti-N IgG antibodies, and hospital course were recorded. Based on lab testing, infections were defined as acute infection or resolving/resolved infection. RESULTS Of the 10 patients admitted with breakthrough infections, all were >70 years of age with multiple comorbidities. Mean time between second vaccine dose and COVID-19 diagnosis was 49 days. In the 7 individuals with acute infection, none had observed serologic response to mRNA vaccination, 5 developed severe disease, and 1 died. Three individuals had anti-N IgG antibodies and a high polymerase chain reaction cycle threshold value, suggesting resolving/resolved infection. CONCLUSIONS Given the variability of vaccine breakthrough infections requiring hospitalization, serologic testing may impart clarity on timing of infection and disease prognosis. Individuals at risk of diminished response to vaccines and severe COVID-19 may also benefit from selective serologic testing after vaccination to guide risk mitigation strategies in a post-pandemic environment.
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Factors Affecting Initial Humoral Immune Response to SARS-CoV-2 Vaccines Among Patients With Inflammatory Bowel Diseases. Am J Gastroenterol 2022; 117:462-469. [PMID: 35029167 DOI: 10.14309/ajg.0000000000001619] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/27/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Although an additional coronavirus disease 2019 vaccine dose for immunocompromised persons has been recommended in some countries, further data to guide vaccination strategies for patients with inflammatory bowel disease (IBD) are urgently needed. We sought to identify factors affecting initial humoral immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines among patients with IBD. METHODS In this prospective cohort of SARS-CoV-2 immunized patients with IBD, we evaluated associations between participant age, sex, vaccine type, medication use, and the presence of a detectable antireceptor binding domain antibody and quantitative antibody level. RESULTS In total, 1,909 participants were included (1,123, 692, and 94 received BNT162b2, mRNA-1273, and Ad26.COV2.S, respectively) of whom 96% achieved a positive antibody response. On multivariable analysis, factors associated with lack of antibody response were older age (P = 0.043), BNT162b2 vs mRNA-1273 (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.0-3.9), and combination therapy with anti-TNF and 6MP, azathioprine, or methotrexate (OR 4.2, 95% CI 2.4-7.3). The use of 5-aminosalicylate or sulfasalazine (OR 0.3, 95% CI 0.1-0.8) and ustekinumab (OR 0.2, 95% CI 0.05-0.8) was associated with decreased odds of lacking antibody response. DISCUSSION Most patients with IBD mount an initial response to SARS-CoV-2 vaccination; however, older patients and those treated with anti-TNF and immunomodulator have blunted responses and may benefit the most from an additional vaccine dose. Patients treated with other classes of immunosuppressive medications have more robust initial immune responses to vaccination. These data should inform key decisions about patient selection for additional coronavirus disease 2019 vaccine doses in patients with IBD.
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Marra AR, Kobayashi T, Suzuki H, Alsuhaibani M, Tofaneto BM, Bariani LM, Auler MDA, Salinas JL, Edmond MB, Doll M, Kutner JM, Pinho JRR, Rizzo LV, Miraglia JL, Schweizer ML. Short-term effectiveness of COVID-19 vaccines in immunocompromised patients: A systematic literature review and meta-analysis. J Infect 2022; 84:297-310. [PMID: 34982962 PMCID: PMC8720049 DOI: 10.1016/j.jinf.2021.12.035] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/20/2021] [Accepted: 12/27/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES We aimed to assess the short-term effectiveness of COVID-19 vaccines among immunocompromised patients to prevent laboratory-confirmed symptomatic COVID-19 infection. METHODS Systematic review and meta-analysis. We calculated the pooled diagnostic odds ratio [DOR] (95% CI) for COVID-19 infection between immunocompromised patients and healthy people or those with stable chronic medical conditions. VE was estimated as 100% x (1-DOR). We also investigated the rates of developing anti-SARS-CoV-2 spike protein IgG between the 2 groups. RESULTS Twenty studies evaluating COVID-19 vaccine response, and four studies evaluating VE were included in the meta-analysis. The pooled DOR for symptomatic COVID-19 infection in immunocompromised patients was 0.296 (95% CI: 0.108-0.811) with an estimated VE of 70.4% (95% CI: 18.9%- 89.2%). When stratified by diagnosis, IgG antibody levels were much higher in the control group compared to immunocompromised patients with solid organ transplant (pOR 232.3; 95% Cl: 66.98-806.03), malignant diseases (pOR 42.0, 95% Cl: 11.68-151.03), and inflammatory rheumatic diseases (pOR 19.06; 95% Cl: 5.00-72.62). CONCLUSIONS We found COVID-19 mRNA vaccines were effective against symptomatic COVID-19 among the immunocompromised patients but had lower VE compared to the controls. Further research is needed to understand the discordance between antibody production and protection against symptomatic COVID-19 infection.
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Affiliation(s)
- Alexandre R Marra
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Hospital Israelita Albert Einstein, Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, Brazil; Center for Access and Delivery Research and Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa, IA, USA.
| | - Takaaki Kobayashi
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Hiroyuki Suzuki
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Center for Access and Delivery Research and Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa, IA, USA
| | - Mohammed Alsuhaibani
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Department of Pediatrics, College of Medicine, Qassim University, Qassim, Saudi Arabia
| | | | | | | | | | - Michael B Edmond
- West Virginia University School of Medicine, Morgantown, WV, USA
| | - Michelle Doll
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | | | | | - Luiz Vicente Rizzo
- Hospital Israelita Albert Einstein, Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, Brazil
| | - João Luiz Miraglia
- Saúde Populacional, Diretoria de Medicina Diagnóstica Ambulatorial, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marin L Schweizer
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Center for Access and Delivery Research and Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa, IA, USA
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Notarte KI, Ver AT, Velasco JV, Pastrana A, Catahay JA, Salvagno GL, Yap EPH, Martinez-Sobrido L, B Torrelles J, Lippi G, Henry BM. Effects of age, sex, serostatus, and underlying comorbidities on humoral response post-SARS-CoV-2 Pfizer-BioNTech mRNA vaccination: a systematic review. Crit Rev Clin Lab Sci 2022; 59:373-390. [PMID: 35220860 PMCID: PMC8935447 DOI: 10.1080/10408363.2022.2038539] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
With the advent of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic, several vaccines have been developed to mitigate its spread and prevent adverse consequences of the Coronavirus Disease 2019 (COVID-19). The mRNA technology is an unprecedented vaccine, usually given in two doses to prevent SARS-CoV-2 infections. Despite effectiveness and safety, inter-individual immune response heterogeneity has been observed in recipients of mRNA-based vaccines. As a novel disease, the specific immune response mechanism responsible for warding off COVID-19 remains unclear at this point. However, significant evidence suggests that humoral response plays a crucial role in affording immunoprotection and preventing debilitating sequelae from COVID-19. As such, this paper focused on the possible effects of age, sex, serostatus, and comorbidities on humoral response (i.e. total antibodies, IgG, and/or IgA) of different populations post-mRNA-based Pfizer-BioNTech vaccination. A systematic search of literature was performed through PubMed, Cochrane CENTRAL, Google Scholar, Science Direct, medRxiv, and Research Square. Studies were included if they reported humoral response to COVID-19 mRNA vaccines. A total of 32 studies were identified and reviewed, and the percent differences of means of reported antibody levels were calculated for comparison. Findings revealed that older individuals, male sex, seronegativity, and those with more comorbidities mounted less humoral immune response. Given these findings, several recommendations were proposed regarding the current vaccination practices. These include giving additional doses of vaccination for immunocompromised and elderly populations. Another recommendation is conducting clinical trials in giving a combined scheme of mRNA vaccines, protein vaccines, and vector-based vaccines.
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Affiliation(s)
- Kin Israel Notarte
- Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines
| | | | | | - Adriel Pastrana
- Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines
| | | | - Gian Luca Salvagno
- Service of Laboratory Medicine, Pederzoli Hospital, Peschiera del Garda, Italy.,Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Eric Peng Huat Yap
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Luis Martinez-Sobrido
- Disease Intervention & Prevention and Population Health Programs, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Jordi B Torrelles
- Disease Intervention & Prevention and Population Health Programs, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Brandon Michael Henry
- Disease Intervention & Prevention and Population Health Programs, Texas Biomedical Research Institute, San Antonio, TX, USA.,Division of Nephrology and Hypertension, Clinical Laboratory, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Al Jurdi A, Gassen RB, Borges TJ, Solhjou Z, Hullekes FE, Lape IT, Efe O, Alghamdi A, Patel P, Choi JY, Mohammed MT, Bohan B, Pattanayak V, Rosales I, Cravedi P, Kotton CN, Azzi JR, Riella LV. Non-Invasive Monitoring for Rejection in Kidney Transplant Recipients After SARS-CoV-2 mRNA Vaccination. Front Immunol 2022; 13:838985. [PMID: 35281011 PMCID: PMC8913529 DOI: 10.3389/fimmu.2022.838985] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/08/2022] [Indexed: 01/14/2023] Open
Abstract
Introduction Studies have shown reduced antiviral responses in kidney transplant recipients (KTRs) following SARS-CoV-2 mRNA vaccination, but data on post-vaccination alloimmune responses and antiviral responses against the Delta (B.1.617.2) variant are limited. Materials and methods To address this issue, we conducted a prospective, multi-center study of 58 adult KTRs receiving mRNA-BNT162b2 or mRNA-1273 vaccines. We used multiple complementary non-invasive biomarkers for rejection monitoring including serum creatinine, proteinuria, donor-derived cell-free DNA, peripheral blood gene expression profile (PBGEP), urinary CXCL9 mRNA and de novo donor-specific antibodies (DSA). Secondary outcomes included development of anti-viral immune responses against the wild-type and Delta variant of SARS-CoV-2. Results At a median of 85 days, no KTRs developed de novo DSAs and only one patient developed acute rejection following recent conversion to belatacept, which was associated with increased creatinine and urinary CXCL9 levels. During follow-up, there were no significant changes in proteinuria, donor-derived cell-free DNA levels or PBGEP. 36% of KTRs in our cohort developed anti-wild-type spike antibodies, 75% and 55% of whom had neutralizing responses against wild-type and Delta variants respectively. A cellular response against wild-type S1, measured by interferon-γ-ELISpot assay, developed in 38% of KTRs. Cellular responses did not differ in KTRs with or without antibody responses. Conclusions SARS-CoV-2 mRNA vaccination in KTRs did not elicit a significant alloimmune response. About half of KTRs who develop anti-wild-type spike antibodies after two mRNA vaccine doses have neutralizing responses against the Delta variant. There was no association between anti-viral humoral and cellular responses.
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Affiliation(s)
- Ayman Al Jurdi
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA, United States
| | - Rodrigo B. Gassen
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA, United States
| | - Thiago J. Borges
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA, United States
| | - Zhabiz Solhjou
- Transplantation Research Center, Renal Division, Brigham and Women’s Hospital, Boston, MA, United States
| | - Frank E. Hullekes
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA, United States
| | - Isadora T. Lape
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA, United States
| | - Orhan Efe
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA, United States
| | - Areej Alghamdi
- Transplantation Research Center, Renal Division, Brigham and Women’s Hospital, Boston, MA, United States
| | - Poojan Patel
- Transplantation Research Center, Renal Division, Brigham and Women’s Hospital, Boston, MA, United States
| | - John Y. Choi
- Transplantation Research Center, Renal Division, Brigham and Women’s Hospital, Boston, MA, United States
| | - Mostafa T. Mohammed
- Transplantation Research Center, Renal Division, Brigham and Women’s Hospital, Boston, MA, United States
- Clinical Pathology Department, Minia University, Minya, Egypt
| | - Brigid Bohan
- Histocompatibility Laboratory, Massachusetts General Hospital, Boston, MA, United States
| | - Vikram Pattanayak
- Department of Pathology, Massachusetts General Hospital, Boston, MA, United States
| | - Ivy Rosales
- Department of Pathology, Massachusetts General Hospital, Boston, MA, United States
| | - Paolo Cravedi
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Camille N. Kotton
- Transplant and Immunocompromised Host Infectious Diseases Infectious Diseases Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Jamil R. Azzi
- Transplantation Research Center, Renal Division, Brigham and Women’s Hospital, Boston, MA, United States
| | - Leonardo V. Riella
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA, United States
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Jahn M, Korth J, Dorsch O, Anastasiou OE, Krawczyk A, Brochhagen L, van de Sand L, Sorge-Hädicke B, Tyczynski B, Witzke O, Dittmer U, Dolff S, Wilde B, Kribben A. Decline of Humoral Responses 6 Months after Vaccination with BNT162b2 (Pfizer–BioNTech) in Patients on Hemodialysis. Vaccines (Basel) 2022; 10:vaccines10020327. [PMID: 35214785 PMCID: PMC8878048 DOI: 10.3390/vaccines10020327] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/04/2022] [Accepted: 02/15/2022] [Indexed: 02/04/2023] Open
Abstract
This study analyzed binding and neutralizing antibody titers up to 6 months after standard vaccination with BNT162b2 (two doses of 30 µg each) in SARS-CoV-2 naïve patients (n = 59) on hemodialysis. Humoral vaccine responses were measured before and 6, 12, and 24 weeks after the first vaccination. A chemiluminescent immunoassay (CLIA) was used to quantify SARS-CoV-2 IgG against the spike glycoprotein. SARS-CoV-2 neutralizing activity was tested against the wild-type virus. A multivariable binary regression model was used to identify risk factors for the absence of humoral immune responses at 6 months. At week 6, vaccine-specific seroconversion was detected in 96.6% of all patients with median anti-SARS-CoV-2 IgGs of 918 BAU/mL. At weeks 12 and 24, seroconversion rates decreased to 91.5% and 79.7%, and corresponding median binding antibody titers declined to 298 BAU/mL and 89 BAU/mL, respectively. Neutralizing antibodies showed a decay from 79.6% at week 6 to 32.8% at week 24. The risk factor with the strongest association for vanishing immune responses was low serum albumin (p = 0.018). Regarding vaccine-specific humoral responses 6 months after the standard BNT162b2 vaccination schedule, SARS-CoV-2 naïve patients receiving hemodialysis must be considered at risk of becoming infected with SARS-CoV-2 and being infectious.
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Affiliation(s)
- Michael Jahn
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (J.K.); (B.T.); (B.W.); (A.K.)
- Correspondence:
| | - Johannes Korth
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (J.K.); (B.T.); (B.W.); (A.K.)
| | - Oliver Dorsch
- KfH Kuratorium für Dialyse und Nierentransplantation e.V, Friesener Straße 37a, 96317 Kronach, Germany;
| | - Olympia Evdoxia Anastasiou
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Virchowstr. 179, 45147 Essen, Germany; (O.E.A.); (U.D.)
| | - Adalbert Krawczyk
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (A.K.); (L.B.); (L.v.d.S.); (O.W.); (S.D.)
| | - Leonie Brochhagen
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (A.K.); (L.B.); (L.v.d.S.); (O.W.); (S.D.)
| | - Lukas van de Sand
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (A.K.); (L.B.); (L.v.d.S.); (O.W.); (S.D.)
| | - Burkhard Sorge-Hädicke
- KfH Kuratorium für Dialyse und Nierentransplantation e.V, Alfried-Krupp-Str. 43, 45131 Essen, Germany;
| | - Bartosz Tyczynski
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (J.K.); (B.T.); (B.W.); (A.K.)
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (A.K.); (L.B.); (L.v.d.S.); (O.W.); (S.D.)
| | - Ulf Dittmer
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Virchowstr. 179, 45147 Essen, Germany; (O.E.A.); (U.D.)
| | - Sebastian Dolff
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (A.K.); (L.B.); (L.v.d.S.); (O.W.); (S.D.)
| | - Benjamin Wilde
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (J.K.); (B.T.); (B.W.); (A.K.)
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (J.K.); (B.T.); (B.W.); (A.K.)
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Mehrabi Nejad MM, Moosaie F, Dehghanbanadaki H, Haji Ghadery A, Shabani M, Tabary M, Aryannejad A, SeyedAlinaghi S, Rezaei N. Immunogenicity of COVID-19 mRNA vaccines in immunocompromised patients: a systematic review and meta-analysis. Eur J Med Res 2022; 27:23. [PMID: 35151362 PMCID: PMC8840778 DOI: 10.1186/s40001-022-00648-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/28/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Immunocompromised (IC) patients are at higher risk of severe SARS-CoV-2 infection, morbidity, and mortality compared to the general population. They should be prioritized for primary prevention through vaccination. This study aimed to evaluate the efficacy of COVID-19 mRNA vaccines in IC patients through a systematic review and meta-analysis approach. METHOD PubMed-MEDLINE, Scopus, and Web of Science were searched for original articles reporting the immunogenicity of two doses of mRNA COVID-19 vaccines in adult patients with IC condition between June 1, 2020 and September 1, 2021. Meta-analysis was performed using either random or fixed effect according to the heterogeneity of the studies. Subgroup analysis was performed to identify potential sources of heterogeneity. RESULTS A total of 26 studies on 3207 IC patients and 1726 healthy individuals were included. The risk of seroconversion in IC patients was 48% lower than those in controls (RR = 0.52 [0.42, 0.65]). IC patients with autoimmune conditions were 54%, and patients with malignancy were 42% more likely to have positive seroconversion than transplant recipients (P < 0.01). Subgroup meta-analysis based on the type of malignancy, revealed significantly higher proportion of positive seroconversion in solid organ compared to hematologic malignancies (RR = 0.88 [0.85, 0.92] vs. 0.61 [0.44, 0.86], P = 0.03). Subgroup meta-analysis based on type of transplantation (kidney vs. others) showed no statistically significant between-group difference of seroconversion (P = 0.55). CONCLUSIONS IC patients, especially transplant recipients, developed lower immunogenicity with two-dose of COVID-19 mRNA vaccines. Among patients with IC, those with autoimmune conditions and solid organ malignancies are mostly benefited from COVID-19 vaccination. Findings from this meta-analysis could aid healthcare policymakers in making decisions regarding the importance of the booster dose or more strict personal protections in the IC patients.
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Affiliation(s)
- Mohammad-Mehdi Mehrabi Nejad
- Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Fatemeh Moosaie
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hojat Dehghanbanadaki
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdolkarim Haji Ghadery
- Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mahya Shabani
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Tabary
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Armin Aryannejad
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran.
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Qarib St, Keshavarz Blvd, 1419733141, Tehran, Iran.
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Davidov Y, Tsaraf K, Cohen‐Ezra O, Likhter M, Ben Yakov G, Levy I, Levin EG, Lustig Y, Mor O, Rahav G, Ben Ari Z. Immunogenicity and Adverse Effects of the 2-Dose BNT162b2 Messenger RNA Vaccine Among Liver Transplantation Recipients. Liver Transpl 2022; 28:215-223. [PMID: 34767690 PMCID: PMC8661838 DOI: 10.1002/lt.26366] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 10/10/2021] [Accepted: 10/23/2021] [Indexed: 12/14/2022]
Abstract
The BNT162b2 messenger RNA (mRNA) vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been shown to be safe and effective in immunocompetent patients. The safety and efficacy of this vaccine in liver transplantation (LT) recipients is still under evaluation. The objective of this study was to assess the safety and efficacy of the BNT162b2 vaccine among transplant recipients. The immune responses of 76 LT recipients receiving 2 doses of the vaccine were compared with those of 174 age-matched immunocompetent controls. Postvaccination immunoglobulin G (IgG) antibodies against the receptor-binding domain (RBD) of SARS-CoV-2 and neutralizing antibodies (NA) to the BNT162b2 mRNA vaccine were determined at least 14 days after the second dose of the vaccine. IgG antibody titers ≥1.1 were defined as positive antibodies. Adverse effects were monitored during the study period. Following administration of the second dose, transplant recipients showed reduced immune responses compared with controls (72% versus 94.2%; P < 0.001). At a median time of 38 days after the second vaccination, the geometric mean of RBD IgG and NA titers were 2.1 (95% confidence interval [CI], 1.6-2.6) and 150 (95% CI, 96-234) among transplant recipients and 4.6 (95% CI, 4.1-5.1) and 429 (95% CI, 350-528) in the control group, respectively (P < 0.001). Antibody responses were lower in transplant recipients who were receiving combined immunosuppression therapy and in those with impaired renal function. Among the LT recipients with negative antibody responses, 1 became infected with SARS-CoV-2, but no recipients with positive antibody responses became infected. Overall, most (n = 39 [51%]) adverse effects self-reported by transplant recipients were mild and occurred more often in women than in men. Compared with patients who were immunocompetent, LT recipients had lower immune responses. The durability of immune responses to the BNT162b2 vaccine among LT recipients requires further investigation.
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Affiliation(s)
- Yana Davidov
- Liver Diseases CenterSheba Medical CenterTel AvivIsrael
| | - Keren Tsaraf
- Liver Diseases CenterSheba Medical CenterTel AvivIsrael
| | | | | | - Gil Ben Yakov
- Liver Diseases CenterSheba Medical CenterTel AvivIsrael
| | - Itzchak Levy
- Infectious Diseases UnitSheba Medical CenterTel AvivIsrael
- Sackler Faculty of MedicineTel‐Aviv UniversityTel‐AvivIsrael
| | - Einav G. Levin
- Sackler Faculty of MedicineTel‐Aviv UniversityTel‐AvivIsrael
- The Infection Prevention & Control UnitSheba Medical CenterTel HashomerIsrael
| | - Yaniv Lustig
- Sackler Faculty of MedicineTel‐Aviv UniversityTel‐AvivIsrael
- Central Virology LaboratoryMinistry of HealthTel‐HashomerIsrael
| | - Orna Mor
- Sackler Faculty of MedicineTel‐Aviv UniversityTel‐AvivIsrael
- Central Virology LaboratoryMinistry of HealthTel‐HashomerIsrael
| | - Galia Rahav
- Infectious Diseases UnitSheba Medical CenterTel AvivIsrael
- Sackler Faculty of MedicineTel‐Aviv UniversityTel‐AvivIsrael
| | - Ziv Ben Ari
- Liver Diseases CenterSheba Medical CenterTel AvivIsrael
- Sackler Faculty of MedicineTel‐Aviv UniversityTel‐AvivIsrael
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75
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Galmiche S, Luong Nguyen LB, Tartour E, de Lamballerie X, Wittkop L, Loubet P, Launay O. Immunological and clinical efficacy of COVID-19 vaccines in immunocompromised populations: a systematic review. Clin Microbiol Infect 2022; 28:163-177. [PMID: 35020589 PMCID: PMC8595936 DOI: 10.1016/j.cmi.2021.09.036] [Citation(s) in RCA: 111] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Available data show that COVID-19 vaccines may be less effective in immunocompromised populations, who are at increased risk of severe COVID-19. OBJECTIVES We conducted a systematic review of literature to assess immunogenicity, efficacy and effectiveness of COVID-19 vaccines in immunocompromised populations. DATA SOURCES We searched Medline and Embase databases. STUDY ELIGIBILITY CRITERIA, PATIENTS, INTERVENTIONS We included studies of COVID-19 vaccines after complete vaccination in immunocompromised patients until 31 August 2021. Studies with <10 patients, safety data only and case series of breakthrough infections were excluded. METHODS Risk of bias was assessed via the tool developed by the National Institutes of Health on interventional and observational studies. Immunogenicity was assessed through non-response rate defined as no anti-SARS-CoV-2 spike protein antibodies, efficacy and effectiveness by the relative reduction in risk of SARS-CoV-2 infection or COVID-19. We collected factors associated with the risk of non-response. We presented collected data by immunosuppression type. RESULTS We screened 5917 results, included 162 studies. There were 157 on immunogenicity in 25 209 participants, including 7835 cancer or haematological malignancy patients (31.1%), 6302 patients on dialysis (25.0%), 5974 solid organ transplant recipients (23.7%) and 4680 immune-mediated disease patients (18.6%). Proportion of non-responders seemed higher among solid organ transplant recipients (range 18-100%) and patients with haematological malignancy (range 14-61%), and lower in patients with cancer (range 2-36%) and patients on dialysis (range 2-30%). Risk factors for non-response included older age, use of corticosteroids, immunosuppressive or anti-CD20 agent. Ten studies evaluated immunogenicity of an additional dose. Five studies evaluated vaccine efficacy or effectiveness: three on SARS-CoV-2 infection (range 71-81%), one on COVID-19-related hospitalization (62.9%), one had a too small sample size. CONCLUSIONS This systematic review highlights the risk of low immunogenicity of COVID-19 vaccines in immunocompromised populations, especially solid organ transplant recipients and patients with haematological malignancy. Despite lack of vaccine effectiveness data, enhanced vaccine regimens may be necessary.
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Affiliation(s)
- Simon Galmiche
- Assistance Publique - Hôpitaux de Paris (AP-HP), CIC Cochin Pasteur, Hôpital Cochin, Paris, France
| | - Liem Binh Luong Nguyen
- Assistance Publique - Hôpitaux de Paris (AP-HP), CIC Cochin Pasteur, Hôpital Cochin, Paris, France
| | - Eric Tartour
- AP-HP, Immunologie Biologique, Hôpital Européen Georges Pompidou, Paris, France
| | - Xavier de Lamballerie
- Aix Marseille Université, IRD 190, INSERM 1207, Unité des Virus Emergents, UVE, IHU Méditerranée Infection, Marseille, France
| | - Linda Wittkop
- Institut de Santé Publique d'Epidémiologie et de Développement, INSERM, Bordeaux Population Health Research Center, UMR 1219, Centre d'Investigation Clinique-Epidémiologie Clinique 1401, University of Bordeaux, Service d'Information Médicale, CHU de Bordeaux, Pôle de Santé Publique, Bordeaux, France
| | - Paul Loubet
- INSERM U1047, Department of Infectious and Tropical Diseases, CHU Nîmes, Université Montpellier, Nîmes, France
| | - Odile Launay
- Université de Paris, Faculté de Médecine Paris Descartes, AP-PH, Inserm, CIC Cochin Pasteur, Paris, France.
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76
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Yanis A, Haddadin Z, Spieker AJ, Waqfi D, Rankin DA, Talj R, Thomas L, Birdwell KA, Ezzell L, Blair M, Eason J, Varjabedian R, Warren CM, Nochowicz CH, Olson EC, Simmons JD, Yoder S, Guy M, Thomsen I, Chappell JD, Kalams SA, Halasa NB. Humoral and cellular immune responses to the SARS-CoV-2 BNT162b2 vaccine among a cohort of solid organ transplant recipients and healthy controls. Transpl Infect Dis 2022; 24:e13772. [PMID: 34905653 DOI: 10.1111/tid.13772] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/09/2021] [Accepted: 11/16/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with increased morbidity and mortality in solid organ transplant (SOT) recipients. Despite exclusion from SARS-CoV-2 vaccine clinical trials, these individuals were identified as high-risk and prioritized for vaccination in public health guidelines. METHODS We prospectively evaluated humoral and cellular immune responses to two doses of the SARS-CoV-2 mRNA vaccine, BNT162b2, in 56 SOT recipients and 26 healthy controls (HCs). Blood specimens collected from participants prior to each dose and following the second dose were tested for SARS-CoV-2-specific antibodies, as well as CD4+ and CD8+ T-cell responses. RESULTS SOT recipients demonstrated lower mean anti-SARS-CoV-2 antibody levels compared to HCs after each dose, and only 21.6% achieved an antibody response after the second dose within the range of HC responses. Similarly, the percentage of responsive CD4+ and CD8+ T cells in SOT recipients was lower than in HCs. While most HCs showed notable humoral and cellular responses, responses were less concordant in SOT recipients, with some showing evidence of either humoral or cellular response, but not both. CONCLUSION Humoral and cellular immune responses to the BNT162b2 vaccine are markedly reduced in SOT recipients as compared to HCs, suggesting that SOT recipients may benefit from more tailored regimens such as higher dose and/or additional vaccinations.
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Affiliation(s)
- Ahmad Yanis
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Zaid Haddadin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Danya Waqfi
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Danielle A Rankin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Rana Talj
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lora Thomas
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kelly A Birdwell
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lauren Ezzell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marcia Blair
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joan Eason
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rebekkah Varjabedian
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christian M Warren
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Cynthia H Nochowicz
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric C Olson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joshua D Simmons
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sandra Yoder
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Madeline Guy
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Isaac Thomsen
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Spyros A Kalams
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, Tennessee, USA
| | - Natasha B Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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77
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Steiger S, Rossaint J, Zarbock A, Anders HJ. Secondary Immunodeficiency Related to Kidney Disease (SIDKD)-Definition, Unmet Need, and Mechanisms. J Am Soc Nephrol 2022; 33:259-278. [PMID: 34907031 PMCID: PMC8819985 DOI: 10.1681/asn.2021091257] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Kidney disease is a known risk factor for poor outcomes of COVID-19 and many other serious infections. Conversely, infection is the second most common cause of death in patients with kidney disease. However, little is known about the underlying secondary immunodeficiency related to kidney disease (SIDKD). In contrast to cardiovascular disease related to kidney disease, which has triggered countless epidemiologic, clinical, and experimental research activities or interventional trials, investments in tracing, understanding, and therapeutically targeting SIDKD have been sparse. As a call for more awareness of SIDKD as an imminent unmet medical need that requires rigorous research activities at all levels, we review the epidemiology of SIDKD and the numerous aspects of the abnormal immunophenotype of patients with kidney disease. We propose a definition of SIDKD and discuss the pathogenic mechanisms of SIDKD known thus far, including more recent insights into the unexpected immunoregulatory roles of elevated levels of FGF23 and hyperuricemia and shifts in the secretome of the intestinal microbiota in kidney disease. As an ultimate goal, we should aim to develop therapeutics that can reduce mortality due to infections in patients with kidney disease by normalizing host defense to pathogens and immune responses to vaccines.
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Affiliation(s)
- Stefanie Steiger
- Division of Nephrology, Department of Medicine IV, Ludwig Maximilians University Hospital of Munich, Munich, Germany
| | - Jan Rossaint
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Alexander Zarbock
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Hans-Joachim Anders
- Division of Nephrology, Department of Medicine IV, Ludwig Maximilians University Hospital of Munich, Munich, Germany
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78
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Kantauskaite M, Müller L, Kolb T, Fischer S, Hillebrandt J, Ivens K, Andree M, Luedde T, Orth HM, Adams O, Schaal H, Schmidt C, Königshausen E, Rump LC, Timm J, Stegbauer J. Intensity of mycophenolate mofetil treatment is associated with an impaired immune response to SARS-CoV-2 vaccination in kidney transplant recipients. Am J Transplant 2022; 22:634-639. [PMID: 34551181 PMCID: PMC8653081 DOI: 10.1111/ajt.16851] [Citation(s) in RCA: 93] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/03/2021] [Accepted: 09/03/2021] [Indexed: 02/06/2023]
Abstract
Kidney transplant recipients (KTRs) are extremely vulnerable to SARS-CoV-2 infection and show an impaired immune response to SARS-CoV-2 vaccination. We analyzed factors related to vaccination efficiency in KTRs. In a multicenter prospective observational study (NCT04743947), IgG antibodies levels against SARS-CoV-2 spike S1 subunit and their neutralization capacity after SARS-CoV-2 vaccination were analyzed in 225 KTRs and compared to 176 controls. After the vaccination, 56 (24.9%) KTRs became seropositive of whom 68% had neutralizing antibodies. This immune response was significantly lower compared to controls (239 [78-519] BAU/ml versus 1826 [560-3180] BAU/ml for KTRs and controls, p < .0001). The strongest predictor for an impaired response was mycophenolate mofetil (MMF) treatment. Multivariate regression analysis revealed that MMF-free regimen was highly associated with seroconversion (OR 13.25, 95% CI 3.22-54.6; p < .001). In contrast, other immunosuppressive drugs had no significant influence. 187 out of 225 KTRs were treated with MMF of whom 26 (13.9%) developed antibodies. 23 of these seropositive KTRs had a daily MMF dose ≤1 g. Furthermore, higher trough MMF concentrations correlated with lower antibody titers (R -0.354, p < .001) supporting a dose-dependent unfavorable effect of MMF. Our data indicate that MMF dose modification could lead to an improved immune response.
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Affiliation(s)
- Marta Kantauskaite
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Lisa Müller
- Institute of Virology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Thilo Kolb
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- KfH Kuratorium für Dialyse und Nierentransplantation e.V, Düsseldorf, Germany
| | - Svenja Fischer
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Jonas Hillebrandt
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Katrin Ivens
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- KfH Kuratorium für Dialyse und Nierentransplantation e.V, Düsseldorf, Germany
| | - Marcel Andree
- Institute of Virology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Tom Luedde
- Department of Gastroenterology, Hepatology and Infectious diseases, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Hans M. Orth
- Department of Gastroenterology, Hepatology and Infectious diseases, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Ortwin Adams
- Institute of Virology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Heiner Schaal
- Institute of Virology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Claudia Schmidt
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Eva Königshausen
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- KfH Kuratorium für Dialyse und Nierentransplantation e.V, Düsseldorf, Germany
| | - Lars C. Rump
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- KfH Kuratorium für Dialyse und Nierentransplantation e.V, Düsseldorf, Germany
| | - Jörg Timm
- Institute of Virology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Johannes Stegbauer
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- KfH Kuratorium für Dialyse und Nierentransplantation e.V, Düsseldorf, Germany
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79
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Ranabhat K, Saud B, Adhikari S, Bhattarai S, Adhikari R, Luitel BR, Sigdel MR. Anti-SARS-CoV-2 Antibody Level among Renal Transplant Recipients: A Case Report from Nepal. Case Rep Urol 2022; 2022:2889501. [PMID: 35047227 PMCID: PMC8763547 DOI: 10.1155/2022/2889501] [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: 09/24/2021] [Revised: 12/10/2021] [Accepted: 12/22/2021] [Indexed: 11/17/2022] Open
Abstract
Globally, SARS-CoV-2 has caused significant public health burden, mainly in patients with underlying comorbidities including both communicable and noncommunicable diseases. Solid organ transplant recipients under immunesupressive medication are also amongst the high risk group. There is only sparse data on immunity against SARS-CoV-2 infection among renal transplant recipients. In this case report, we present the level of anti-SARS-CoV-2 antibody of three kidney transplant recipients after vaccination against COVID-19 virus. All three cases had received two doses of Oxford-AstraZeneca COVID-19 vaccine AZD1222 (ChAdOx1). Serological analysis showed protective level of circulating antibodies in the blood of all three cases. Although two out of three patients in the study acquired COVID-19 infection after immunization, they recovered with mild clinical course. Hence, we conclude that despite immune-suppressed status of transplant recipients, COVID-19 vaccination could protect them against severe illness.
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Affiliation(s)
- Kamal Ranabhat
- Institue of Medicine, Tribhuvan University, Kathmandu, Nepal
- Ministry of Health and Population, Kathmandu, Nepal
| | - Bhuvan Saud
- Department of Medical Laboratory Technology, Janamaitri Foundation Institute of Health Sciences, Lalitpur, Nepal
| | - Saroj Adhikari
- National Trauma Center, Ministry of Health and Population Kathmandu, Nepal
| | - Suraj Bhattarai
- Global Institute for Interdisciplinary Studies, Kathmandu, Nepal
| | - Rojan Adhikari
- Shahid Dharma Bhakta National Transplant Center, Bhaktapur, Nepal
| | - Bhoj Raj Luitel
- Institue of Medicine, Tribhuvan University, Kathmandu, Nepal
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80
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Russo G, Lai Q, Poli L, Perrone MP, Gaeta A, Rossi M, Mastroianni CM, Garofalo M, Pretagostini R. SARS-COV-2 vaccination with BNT162B2 in renal transplant patients: Risk factors for impaired response and immunological implications. Clin Transplant 2022; 36:e14495. [PMID: 34569101 PMCID: PMC8646240 DOI: 10.1111/ctr.14495] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 12/27/2022]
Abstract
Solid organ transplant patients are at a higher risk for poor CoronaVirus Disease-2019 (COVID-19)-related outcomes and have been included as a priority group in the vaccination strategy worldwide. We assessed the safety and efficacy of a two-dose vaccination cycle with mRNA-based COVID-19 vaccine (BNT162b2) among 82 kidney transplant outpatients followed in our center in Rome, Italy. After a median of 43 post-vaccine days, a SARS-CoV-2 anti-Spike seroprevalence of 52.4% (n = 43/82) was observed. No impact of the vaccination on antibody-mediated rejection or graft function was observed, and no significant safety concerns were reported. Moreover, no de novo HLA-donor-specific antibodies (DSA) were detected during the follow-up period. Only one patient with pre-vaccination HLA-DSA did not experience an increased intensity of the existing HLA-DSA. During the follow-up, only one infection (mild COVID-19) was observed in a patient after receiving the first vaccine dose. According to the multivariable logistic regression analysis, lack of seroconversion after two-dose vaccination independently associated with patient age ≥60 years (OR = 4.50; P = .02) and use of anti-metabolite as an immunosuppressant drug (OR = 5.26; P = .004). Among younger patients not taking anti-metabolites, the seroconversion rate was high (92.9%). Further larger studies are needed to assess the best COVID-19 vaccination strategy in transplanted patients.
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Affiliation(s)
- Gianluca Russo
- Infectious Disease UnitSapienza University of RomeRomeItaly
| | - Quirino Lai
- General Surgery and Organ Transplantation UnitSapienza University of RomeRomeItaly
| | - Luca Poli
- General Surgery and Organ Transplantation UnitSapienza University of RomeRomeItaly
| | - Maria Paola Perrone
- Immunohematology and Transfusion Medicine UnitSapienza University of RomeRomeItaly
| | - Aurelia Gaeta
- Department of Molecular MedicineSapienza University of RomeRomeItaly
| | - Massimo Rossi
- General Surgery and Organ Transplantation UnitSapienza University of RomeRomeItaly
| | | | - Manuela Garofalo
- General Surgery and Organ Transplantation UnitSapienza University of RomeRomeItaly
| | - Renzo Pretagostini
- General Surgery and Organ Transplantation UnitSapienza University of RomeRomeItaly
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81
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Nicastro E, Ebel NH, Kehar M, Czubkowski P, Ng VL, Michaels MG, Lobritto SJ, Martinez M, Indolfi G. The Impact of Severe Acute Respiratory Syndrome Coronavirus Type 2 on Children With Liver Diseases: A Joint European Society for Pediatric Gastroenterology, Hepatology and Nutrition and Society of Pediatric Liver Transplantation Position Paper. J Pediatr Gastroenterol Nutr 2022; 74:159-170. [PMID: 34694269 PMCID: PMC8673661 DOI: 10.1097/mpg.0000000000003339] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 10/16/2021] [Indexed: 02/07/2023]
Abstract
ABSTRACT Children are seldom affected by severe forms of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV2) infection; however, the impact of comorbidities in the clinical presentation and outcome of SARS-CoV2 in children is poorly characterized including that of chronic liver disease (CLD) and those taking immunosuppressive medications for autoimmune liver disease or following liver transplantation (LT). Although not the main target organ, a spectrum of liver involvement has been described in children infected with SARS-CoV2 and those presenting with Multisystem Inflammatory Syndrome in Children (MIS-C). The Hepatology Committee of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the Society of Pediatric Liver Transplantation (SPLIT) present an evidence-based position paper on liver involvement in children with SARS-CoV2 infection and its impact on those with CLD as well as LT recipients. All children may exhibit acute liver injury from SARS-CoV2 infection, and those with CLD and may experience hepatic decompensation. Preventative and therapeutic measures are discussed.
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Affiliation(s)
- Emanuele Nicastro
- Pediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Noelle H. Ebel
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Mohit Kehar
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Piotr Czubkowski
- Department of Gastroenterology, Hepatology, Feeding Disorders and Paediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Vicky L. Ng
- Division of Gastroenterology, Hepatology, and Nutrition, the Hospital for Sick Children, Toronto, ON, Canada
| | - Marian G. Michaels
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Pittsburgh, School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Steven J. Lobritto
- Liver Unit, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Irving Medical Center Morgan Stanley Children's Hospital, New York, NY
| | - Mercedes Martinez
- Liver Unit, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Irving Medical Center Morgan Stanley Children's Hospital, New York, NY
| | - Giuseppe Indolfi
- Meyer Children's University Hospital, Department NEUROFARBA, University of Florence, Firenze, Italy
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Swai J, Gui M, Long M, Wei Z, Hu Z, Liu S. Humoral and cellular immune response to severe acute respiratory syndrome coronavirus-2 vaccination in haemodialysis and kidney transplant patients. Nephrology (Carlton) 2022; 27:7-24. [PMID: 34510645 PMCID: PMC8646800 DOI: 10.1111/nep.13974] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/22/2021] [Accepted: 09/07/2021] [Indexed: 12/26/2022]
Abstract
End-stage renal disease (ESRD) patients are amongst the vulnerable groups and thus prioritized in the Coronavirus disease-2019 vaccination programmes. However, this cohort was excluded from vaccine-trials and yet shares the same vaccination scheme with the general population. Here, we explore trends of immune response-proportions amongst ESRD patients on renal replacement therapy for up to 4 weeks post-vaccination completion with Pfizer/Moderna vaccines. From inception to 10 July 2021, we searched six online-databases for articles reporting humoral and cellular immune response proportions for up to 4 weeks post booster-vaccination. We pooled the responders' proportions by meta-analysis and conducted a meta-regression stratifying outcomes by significant confounders. Twenty-seven eligible studies reported 2789 ESRD patients. 1337, 1452 and 477 were on haemodialysis, received kidney transplantation, and healthy controls, respectively. Haemodialysis patients' proportions of humoral and cellular immune responses varied from 87.29% (80.77-93.81)-88.78% (86.76-90.80) and 62.86% (56.56, 69.17)-85.78% (78.99, 92.57), respectively, between first- and fourth-weeks. Kidney transplant patients' proportions of humoral and cellular immune responses ranged from 2.6% (0.06-13.48)-29.87% (27.68, 32.07) and 5.13% (0.63-17.3)-59.84% (54.57-65.10), respectively, between first- and fourth-weeks. All healthy controls maintained ≥93% proportions of both responses throughout the follow-up. Study design and country of study influenced the pooled response proportions. Conclusively, haemodialysis and kidney transplant patients have lower proportions of humoral and cellular immune responses than healthy controls. However, haemodialysis patients' response proportions improve, reaching near healthy-control levels by the fourth week. Kidney transplant patients' lower responses' proportions also improve but remain significantly lower than healthy controls throughout four-weeks. The "one-size-fits-all" vaccination scheme might be inadequate for kidney transplant patients.
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Affiliation(s)
- Joel Swai
- Division of Nephrology and ImmunologyUniversity of AlbertaEdmontonCanada
- Department of NephrologyBenjamin Mkapa HospitalDodoma CityTanzania
| | - Ming Gui
- Department of Nephrology and RheumatologyThird Xiangya Hospital of Central South UniversityChangshaChina
| | - Mao Long
- Department of Nephrology and RheumatologyThird Xiangya Hospital of Central South UniversityChangshaChina
| | - Zhu Wei
- Department of Infectious DiseasesThird Xiangya Hospital of Central South UniversityChangshaChina
| | - Zixuan Hu
- Department of Internal MedicineThird Xiangya Hospital of Central South UniversityChangshaChina
| | - Shaojun Liu
- Department of Internal MedicineThird Xiangya Hospital of Central South UniversityChangshaChina
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Blain H, Tuaillon E, Gamon L, Pisoni A, Miot S, Rolland Y, Picot M, Bousquet J. Antibody response after one and two jabs of the BNT162b2 vaccine in nursing home residents: The CONsort-19 study. Allergy 2022; 77:271-281. [PMID: 34286856 PMCID: PMC8441741 DOI: 10.1111/all.15007] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 12/13/2022]
Abstract
Background The humoral immune response following COVID‐19 vaccination in nursing home residents is poorly known. A longitudinal study compared levels of IgG antibodies against the spike protein (S‐RBD IgG) (S‐RDB protein IgG) after one and two BNT162b2/Pfizer jabs in residents with and without prior COVID‐19. Methods In 22 French nursing homes, COVID‐19 was diagnosed with real‐time reverse‐transcriptase polymerase chain reaction (RT‐PCR) for SARS‐CoV‐2. Blood S‐RDB‐protein IgG and nucleocapsid (N) IgG protein (N‐protein IgG) were measured 21–24 days after the first jab (1,004 residents) and 6 weeks after the second (820 residents). Results In 735 residents without prior COVID‐19, 41.7% remained seronegative for S‐RDB‐protein IgG after the first jab vs. 2.1% of the 270 RT‐PCR‐positive residents (p < 0.001). After the second jab, 3% of the 586 residents without prior COVID‐19 remained seronegative. However, 26.5% had low S‐RDB‐protein IgG levels (50–1050 UA/ml) vs. 6.4% of the 222 residents with prior COVID‐19. Residents with an older infection (first wave), or with N‐protein IgG at the time of vaccination, had the highest S‐RDB‐protein IgG levels. Residents with a prior COVID‐19 infection had higher S‐RDB‐protein IgG levels after one jab than those without after two jabs. Interpretation A single vaccine jab is sufficient to reach a high humoral immune response in residents with prior COVID‐19. Most residents without prior COVID‐19 are seropositive for S‐RDB‐protein IgG after the second jab, but around 30% have low levels. Whether residents with no or low post‐vaccine S‐RDB protein IgG are at higher risk of symptomatic COVID‐19 requires further analysis.
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Affiliation(s)
- Hubert Blain
- Department of Internal Medicine and Geriatrics MUSE University Montpellier France
| | | | - Lucie Gamon
- Clinical research and epidemiology unit University hospital Montpellier France
| | | | - Stéphanie Miot
- Department of Internal Medicine and Geriatrics MUSE University Montpellier France
| | - Yves Rolland
- INSERM 1027 Gérontopôle de Toulouse Toulouse France
| | | | - Jean Bousquet
- Clinical research and epidemiology unit University hospital Montpellier France
- Department of Dermatology and Allergy Universitätsmedizin Berlin Germany
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Mishra D, Bandyopadhyay K, Nair L, Shashivadhanan S. Patterns of antibody response, adverse effects, and knowledge regarding COVID-19 vaccine: Findings of a serosurvey among vaccinated individuals in North-Western India. JOURNAL OF MARINE MEDICAL SOCIETY 2022. [DOI: 10.4103/jmms.jmms_88_21] [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
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85
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Ben-Dov IZ, Oster Y, Tzukert K, Alster T, Bader R, Israeli R, Asayag H, Aharon M, Burstein I, Pri-Chen H, Imam A, Abel R, Mor-Yosef Levi I, Khalaileh A, Oiknine-Djian E, Bloch A, Wolf DG, Dranitzki Elhalel M. Impact of tozinameran (BNT162b2) mRNA vaccine on kidney transplant and chronic dialysis patients: 3-5 months follow-up. J Nephrol 2022; 35:153-164. [PMID: 34988942 PMCID: PMC8731189 DOI: 10.1007/s40620-021-01210-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/11/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Determining the humoral immunogenicity of tozinameran (BNT162b2) in patients requiring chronic renal replacement therapy, and its impact on COVID-19 morbidity several months after vaccination, may guide risk assessment and changes in vaccination policy. METHODS In a prospective post-vaccination cohort study with up to 5 months follow-up we studied outpatient dialysis and kidney transplant patients and respective healthcare teams. Outcomes were anti S1/S2 antibody responses to vaccine or infection, and infection rate during follow-up. RESULTS One hundred seventy-five dialysis patients (40% women, 65 ± 15 years), 252 kidney transplant patients (33% women, 54 ± 14 years) and 71 controls (65% women, 44 ± 14 years) were followed. Three months or longer after vaccination we detected anti S1/S2 IgG antibodies in 79% of dialysis patients, 42% of transplant recipients and 100% of controls, whereas respective rates after infection were 94%, 69% and 100%. Predictors of non-response were older age, diabetes, history of cancer, lower lymphocyte count and lower vitamin-D levels. Factors associated with lower antibody levels in dialysis patients were modality (hemodialysis vs peritoneal) and high serum ferritin levels. In transplant patients, hypertension and higher calcineurin or mTOR inhibitor drug levels were linked with lower antibody response. Vaccination was associated with fewer subsequent infections (HR 0.23, p < 0.05). Moreover, higher antibody levels (particularly above 59 AU/ml) were associated with fewer events, with a HR 0.41 for each unit increased in log10titer (p < 0.05). CONCLUSIONS Dialysis patients, and more strikingly kidney transplant recipients, mounted reduced antibody response to COVID-19 mRNA vaccination. Lesser humoral response was associated with more infections. Measures to identify and protect non-responsive patients are required.
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Affiliation(s)
- Iddo Z Ben-Dov
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel.
| | - Yonatan Oster
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Keren Tzukert
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
| | - Talia Alster
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
| | - Raneem Bader
- Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ruth Israeli
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
| | - Haya Asayag
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
| | - Michal Aharon
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
| | - Ido Burstein
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
| | - Hadas Pri-Chen
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
| | - Ashraf Imam
- Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Roy Abel
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
| | - Irit Mor-Yosef Levi
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
| | - Abed Khalaileh
- Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Esther Oiknine-Djian
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Aharon Bloch
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
| | - Dana G Wolf
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michal Dranitzki Elhalel
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Kiryat Hadassah 1, 921120, Jerusalem, Israel
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Kute V, Desai S, Meshram H, Shah K, Chauhan S, Mishra V, Sahay M. On the way to mandate booster vaccine dose of coronavirus disease 2019 for transplant recipients: A narrative review of literature. INDIAN JOURNAL OF TRANSPLANTATION 2022. [DOI: 10.4103/ijot.ijot_7_22] [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
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Predictive Factors for Humoral Response After 2-dose SARS-CoV-2 Vaccine in Solid Organ Transplant Patients. Transplant Direct 2021; 8:e1248. [PMID: 34966837 PMCID: PMC8710345 DOI: 10.1097/txd.0000000000001248] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/24/2022] Open
Abstract
Background A weak immunogenicity has been reported in solid organ transplant (SOT) recipients after 2 doses of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. The aim of this retrospective study was to identify the predictive factors for humoral response in SOT patients. Methods Three hundred and ninety-three SOT patients from our center with at least 4 wk of follow-up after 2 doses of mRNA-based vaccine were included in this study. Anti-SARS-Cov-2 spike protein antibodies were assessed before and after vaccination. Results Anti-SARS-CoV-2 antibodies were detected in 34% of the patients: 33.7% of kidney transplant patients, 47.7% of liver transplant patients, and 14.3% of thoracic transplant patients (P = 0.005). Independent predictive factors for humoral response after vaccination were male gender, a longer period between transplantation and vaccination, liver transplant recipients, a higher lymphocyte count at baseline, a higher estimated glomerular filtration rate and receiving the tacrolimus + everolimus ± steroids combination. Conversely, the nondevelopment of anti-SARS-CoV-2 antibodies after vaccination was associated with younger patients, thoracic organ recipients, induction therapy recipients, and tacrolimus + mycophenolic acid ± steroids recipients. Conclusions The immunosuppressive regimen is a modifiable predictive factor for humoral response to SARS-CoV-2 vaccine.
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Antibody Response to mRNA Vaccines against SARS-CoV-2 with Chronic Kidney Disease, Hemodialysis, and after Kidney Transplantation. J Clin Med 2021; 11:jcm11010148. [PMID: 35011888 PMCID: PMC8745313 DOI: 10.3390/jcm11010148] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/21/2021] [Accepted: 12/26/2021] [Indexed: 02/07/2023] Open
Abstract
Most trials on mRNA vaccines against SARS-CoV-2 did not include patients with chronic kidney disease (CKD), hemodialysis (HD) patients, or kidney transplant recipients (KTR). However, those patients have a higher risk for a severe course of COVID-19 disease and mortality. Available literature has demonstrated a reduced efficacy of mRNA vaccines in HD patients and KTR, while data on CKD patients is scarce. Additionally, factors associated with non-response are poorly understood and not well characterized. We assessed antibody (AB) response (n = 582, 160 CKD patients, 206 patients on HD, 216 KTR) after the administration of two doses of a mRNA-vaccine with either BNT162b2 or mRNA-1273. AB measurements were carried out after a median of 91 days after first vaccinations, demonstrating non-response in 12.5% of CKD patients, 12.1% of HD patients, and 50% of KTR. AB titers were significantly higher in CKD patients than in HD patients or KTR. Factors associated with non-response were treated with rituximab in CKD patients, the use of calcineurin inhibitors in HD patients and older age, and the use of BNT162b2, mycophenolic acid, or glucocorticoids and lower hemoglobin levels in KTR. This study contributes to the understanding of the extent and conditions that predispose for non-response in patients with impaired kidney function.
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89
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Seija M, Rammauro F, Santiago J, Orihuela N, Zulberti C, Machado D, Recalde C, Noboa J, Frantchez V, Astesiano R, Yandián F, Guerisoli A, Morra Á, Cassinelli D, Coelho C, de Aramburu B, González-Severgnini P, Moreno R, Pippolo A, López G, Lemos M, Somariva L, López E, Fumero S, Orihuela C, Rodríguez R, Acuña G, Rabaza V, Perg N, Cordero R, Reisfeld C, Olivera P, Montero P, Nogueira C, Nalerio C, Orihuela S, Curi L, Burgstaller E, Noboa O, Pritsch O, Nin M, Bianchi S. Comparison of antibody response to SARS-CoV-2 after two doses of inactivated virus and BNT162b2 mRNA vaccines in kidney transplant. Clin Kidney J 2021; 15:527-533. [PMID: 35198159 PMCID: PMC8755301 DOI: 10.1093/ckj/sfab291] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Indexed: 11/25/2022] Open
Abstract
Background Antibody response against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) after mRNA or adenoviral vector-based vaccines is weak in kidney transplant (KT) patients. However, few studies have focused on humoral response after inactivated virus-based vaccines in KT. Here, we compare antibody response following vaccination with inactivated virus (CoronaVac®) and BNT162b2 mRNA. Methods A national multicentre cross-sectional study was conducted. The study group was composed of patients from all KT centres in Uruguay, vaccinated between 1 and 31 May 2021 (CoronaVac®, n = 245 and BNT162b2, n = 39). The control group was constituted of 82 healthy individuals. Participants had no prior confirmed coronavirus disease 2019 (COVID-19) test. Blood samples were collected between 30 and 40 days after the second dose. Serum-specific immunoglobulin G (IgG) antibodies against the receptor-binding domain (RBD) of SARS-CoV-2 Spike protein were determined using the COVID-19 IgG QUANT ELISA Kit. Results Only 29% of KT recipients showed seroconversion (36.5% BNT162b2, 27.8% inactivated virus, P = 0.248) in comparison with 100% in healthy control with either vaccine. Antibody levels against RBD were higher with BNT162b mRNA than with inactivated virus [median (interquartile range) 173 (73–554) and 29 (11–70) binding antibody units (BAU)/mL, P < 0.034] in KT and 10 times lower than healthy control [inactivated virus: 308 (209–335) and BNT162b2: 2638 (2608–3808) BAU/mL, P < 0.034]. In multivariate analysis, variables associated with negative humoral response were age, triple immunosuppression, estimated glomerular filtration rate and time post-KT. Conclusion Seroconversion was low in KT patients after vaccination with both platforms. Antibody levels against SARS-CoV-2 were lower with inactivated virus than BNT162b mRNA. These findings support the need for strategies to improve immunogenicity in KT recipients after two doses of either vaccine.
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Affiliation(s)
- Mariana Seija
- Centro de Nefrología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
- Departamento de Fisiopatología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Florencia Rammauro
- Laboratorio de Inmunovirología, Institut Pasteur de Montevideo, Montevideo, Uruguay
- Departamento de Inmunobiología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - José Santiago
- Centro de Nefrología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Natalia Orihuela
- Centro de Trasplante INU, Hospital Italiano, Montevideo, Uruguay
| | | | - Danilo Machado
- Centro de Trasplante, Hospital Evangélico, Montevideo, Uruguay
| | - Cecilia Recalde
- Centro de Trasplante, Hospital Evangélico, Montevideo, Uruguay
| | - Javier Noboa
- Centro de Nefrología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
- Departamento de Inmunobiología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Victoria Frantchez
- Cátedra de Enfermedades Infecciosas, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Rossana Astesiano
- Centro de Nefrología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Federico Yandián
- Centro de Nefrología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Ana Guerisoli
- Centro de Nefrología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Álvaro Morra
- Centro de Trasplante INU, Hospital Italiano, Montevideo, Uruguay
| | - Daniela Cassinelli
- Students of Scientific Methods 2, Medical Doctor Degree, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Cecilia Coelho
- Students of Scientific Methods 2, Medical Doctor Degree, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Belén de Aramburu
- Students of Scientific Methods 2, Medical Doctor Degree, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Paulina González-Severgnini
- Students of Scientific Methods 2, Medical Doctor Degree, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Romina Moreno
- Students of Scientific Methods 2, Medical Doctor Degree, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Aldana Pippolo
- Students of Scientific Methods 2, Medical Doctor Degree, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Gabriela López
- Departamento de Enfermería, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Mónica Lemos
- Departamento de Enfermería, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Lorena Somariva
- Departamento de Enfermería, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Eliana López
- Departamento de Enfermería, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Soledad Fumero
- Departamento de Enfermería, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Carla Orihuela
- Departamento de Enfermería, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | | | - Gonzalo Acuña
- Centro de Trasplante, Hospital Evangélico, Montevideo, Uruguay
| | - Victoria Rabaza
- Centro de Trasplante, Hospital Evangélico, Montevideo, Uruguay
| | - Nancy Perg
- Centro de Trasplante, Hospital Evangélico, Montevideo, Uruguay
| | - Rossana Cordero
- Centro de Trasplante, Hospital Evangélico, Montevideo, Uruguay
| | | | - Paula Olivera
- Centro de Trasplante, Hospital Evangélico, Montevideo, Uruguay
| | - Paola Montero
- Centro de Trasplante, Hospital Evangélico, Montevideo, Uruguay
| | | | - Catheryn Nalerio
- Centro de Trasplante INU, Hospital Italiano, Montevideo, Uruguay
| | - Sergio Orihuela
- Centro de Trasplante INU, Hospital Italiano, Montevideo, Uruguay
| | - Lilián Curi
- Centro de Trasplante INU, Hospital Italiano, Montevideo, Uruguay
| | - Ema Burgstaller
- Centro de Trasplante, Hospital Evangélico, Montevideo, Uruguay
| | - Oscar Noboa
- Centro de Nefrología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Otto Pritsch
- Laboratorio de Inmunovirología, Institut Pasteur de Montevideo, Montevideo, Uruguay
- Departamento de Inmunobiología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Marcelo Nin
- Centro de Nefrología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
- Centro de Trasplante INU, Hospital Italiano, Montevideo, Uruguay
| | - Sergio Bianchi
- Departamento de Fisiopatología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
- Laboratorio de Genómica Funcional, Institut Pasteur de Montevideo, Montevideo, Uruguay
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Immune Response to BNT162b2 in Solid Organ Transplant Recipients: Negative Impact of Mycophenolate and High Responsiveness of SARS-CoV-2 Recovered Subjects against Delta Variant. Microorganisms 2021; 9:microorganisms9122622. [PMID: 34946223 PMCID: PMC8707090 DOI: 10.3390/microorganisms9122622] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 12/24/2022] Open
Abstract
The immunogenicity of severe acute respiratory syndrome 2 virus (SARS-CoV-2) vaccines in immunocompromised patients remains to be further explored. Here, we evaluated the immunogenicity elicited by complete vaccination with BNT162b2 vaccine in solid organ transplant recipients (SOTRs). A cohort of 110 SOTRs from Northern Italy were vaccinated with two doses of BNT162b2 mRNA vaccine and prospectively monitored at baseline and after 42 days. Both SARS-CoV-2 naïve and recovered subjects were included. Humoral response elicited by vaccination, including SARS-CoV-2 neutralizing antibodies (SARS-CoV-2 NT Abs), was evaluated; additionally, ex-vivo ELISpot assay was performed for the quantification of Spike-specific T-cell response. Results were compared with those obtained in a cohort of healthy subjects. In a subset of patients, humoral and T-cell responses against delta variant were also evaluated. Less than 20% of transplanted subjects developed a positive humoral and cell-mediated response after complete vaccination schedule. Overall, median levels of immune response elicited by vaccination were significantly lower with respect to controls in SARS-CoV-2 naïve transplant, but not in SARS-CoV-2 recovered transplanted patients. Additionally, a significant impairment of both humoral and cell-mediated response was observed in mycophenolate-treated patients. Positive delta-SARS-CoV-2 NT Abs levels were detected in almost all the SARS-CoV-2 recovered subjects but not in previously uninfected patients. Our study supports previous observations of a low level of seroconversion after vaccination in transplanted patients.
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Risk Factors Associated With an Impaired Antibody Response in Kidney Transplant Recipients Following 2 Doses of the SARS-CoV-2 mRNA Vaccine. Transplant Direct 2021; 8:e1257. [PMID: 34912946 PMCID: PMC8670582 DOI: 10.1097/txd.0000000000001257] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 09/13/2021] [Indexed: 01/10/2023] Open
Abstract
Background. Data about vaccine efficacy in solid organ transplant patients are limited. We previously reported our initial observation of a 6.2% immunogenicity rate in kidney transplant recipients (KTRs) after administration of 1 dose of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccine. We sought to report our observations of anti-SARS-CoV-2 antibody in KTRs after 2 doses of the SARS-CoV-2 mRNA vaccine. Methods. We identified 105 KTRs who received 2 doses of the Pfizer-BioNTech or Moderna mRNA-1273 vaccine per availability and had anti-SARS-CoV-2 labs obtained at least 2 wk following administration of the second dose. Antibody testing was performed using 3 clinically validated qualitative and semiquantitative assays. Results. KTRs had a 36.2% antibody response rate, whereas an age ≥68 years and a longer time from transplant were factors associated with antibody response. Conclusions. The low antibody response in KTRs may be associated with the immunosuppressive state. More data are needed to evaluate if KTRs may require higher vaccine doses or an additional booster dose to increase their ability to mount an immune response to the SARS-CoV-2 vaccine.
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Unexpectedly High Efficacy of SARS-CoV-2 BNT162b2 Vaccine in Liver versus Kidney Transplant Recipients-Is It Related to Immunosuppression Only? Vaccines (Basel) 2021; 9:vaccines9121454. [PMID: 34960200 PMCID: PMC8703477 DOI: 10.3390/vaccines9121454] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 12/28/2022] Open
Abstract
The BNT162b2 vaccine is reportedly effective in preventing severe disease in more than 90% of the general population, but its efficacy in transplant recipients remains controversial. We aimed to determine the immune response to the BNT162b2 vaccine in kidney (KTRs) and liver transplant recipients (LTRs). In this retrospective cohort study, we included randomly 65 KTRs and 65 LTRs, who received two 30 μg doses of BNT162b2 vaccine in 3-to6-week intervals. We analyzed the anti-SARS-CoV-2 spike protein IgG antibody (anti-S1 Ab) titer, biochemical liver and renal tests, immunosuppressive drug trough level, and clinical follow up 4-6 weeks after the first dose and 4-8 weeks after the second dose. The level of protective antibodies was 57.1% in KTRs and 88.9% in LTRs after the second dose. The anti-S1 Ab response was significantly associated with sex, age, and history of COVID-19. A tacrolimus dose at vaccination but not its trough level was significantly correlated with the increase in anti-S1 Ab titer after the second vaccine dose in LTRs. Rejection episodes did not occur after vaccination. Our results showed a higher than previously reported humoral response to the BNT162b2 vaccine in KTRs and LTRs, which was dependent upon age, type of transplanted organ, and immunosuppression.
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93
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Immune Response after SARS-CoV-2 Vaccination in Kidney Transplant Patients. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57121327. [PMID: 34946272 PMCID: PMC8703670 DOI: 10.3390/medicina57121327] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/22/2021] [Accepted: 12/01/2021] [Indexed: 01/14/2023]
Abstract
Background and Objectives: The prospective study was conducted to evaluate humoral and cellular immune responses after two doses of BNT162b2 (Pfizer-BioNTech) vaccine and possible relation with other factors (medication, etc.) in kidney transplant patients. Materials and Methods: Out of 167 vaccinated patients, 136 agreed to a follow-up visit three to six weeks after vaccination. Results: Only 39 patients (29%) developed antibody response against SARS-CoV-2 (≥35.2 binding antibody units (BAU)/mL) after full vaccination. Multivariate binary logistic regression analysis showed that predictive factors for good antibody response to the COVID-19 vaccine were better kidney function, higher hemoglobin level, and no use of mycophenolate mofetil for immunosuppression. For seropositive kidney transplant patients there was a significant negative correlation between anti-SARS-CoV-2 antibody titer and CD4/CD8 ratio (Spearman's correlation coefficient -0.4, p = 0.02), percentage of CD19+ cells (r = -0.37, p = 0.02), and a positive correlation with percentage of CD8+ cells (r = 0.4, p = 0.01). There was an increase of total leucocyte count after vaccination in the total studied population, and in the group of responders. Conclusions: Only one third of kidney transplant patients develop sufficient antibody responses after full COVID-19 vaccination with Pfizer-BioNTech. Better kidney function, higher hemoglobin level, and no use of mycophenolate mofetil for immunosuppression increases the adequacy of response. The antibody titers correlated positively with relative number of CD8+ cells and negatively with CD4/CD8 ratio in responders.
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Eren Sadioğlu R, Demir E, Evren E, Aktar M, Şafak S, Artan AS, Meşe S, Ağaçfidan A, Çınar G, Önel M, Karahan ZC, Şengül Ş, Keven K, Türkmen A. Antibody response to two doses of inactivated SARS-CoV-2 vaccine (CoronaVac) in kidney transplant recipients. Transpl Infect Dis 2021; 23:e13740. [PMID: 34606134 PMCID: PMC8646873 DOI: 10.1111/tid.13740] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/13/2021] [Accepted: 09/19/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Coronavirus Disease-19 (COVID-19) has high mortality in kidney transplant recipients (KTR), and vaccination against severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) is vital for this population. Although the humoral response to messenger RNA vaccines was shown to be impaired in KTR, there is a lack of data regarding the antibody response to inactivated vaccines. We investigated the antibody response to two consequent doses of the inactivated SARS-CoV-2 vaccine (CoronaVac; Sinovac Biotech, China). METHODS A total of 118 patients from two centers were included. The levels of anti-SARS-CoV-2 immunoglobulin-G antibodies against the nucleocapsid and spike antigens were determined with enzyme immunoassay (DIA.PRO; Milano, Italy) before the vaccine and one month after the second dose of the vaccine. Thirty-three patients were excluded due to antibody positivity in the serum samples obtained before vaccination. RESULTS Eighty-five patients, 47 of whom were female, with a mean age of 46 ± 12, were included in the statistical analysis. The maintenance immunosuppressive therapy comprised tacrolimus (88.2%), mycophenolate (63.6%), and low-dose steroids (95.3%) in the majority of the patients. After a median of 31 days following the second dose of the vaccine, only 16 (18.8%) patients developed an antibody response. The median (IQR) antibody level was 52.5 IU/ml (21.5-96). Age (48 vs. 38, p = .005) and serum creatinine levels (1.14 vs. 0.91, p = .04) were higher in non-responders and were also found to be independently associated with the antibody response (odds ratio (OR): 0.93, p = 0.012 and 0.15, p = 0.045, respectively) in multivariate analysis. CONCLUSION In this study, we found the antibody response to the inactivated vaccine to be considerably low (18.8%) in KTR. Increased age and impaired renal function were associated with worse antibody response. Based on the knowledge that mRNA vaccines yield better humoral responses, this special population might be considered for additional doses of mRNA vaccination.
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Affiliation(s)
- Rezzan Eren Sadioğlu
- Department of Nephrology, Ankara University School of MedicineAnkara UniversityAnkaraTurkey
| | - Erol Demir
- Department of Nephrology, Istanbul School of MedicineIstanbul UniversityIstanbulTurkey
| | - Ebru Evren
- Department of Medical Microbiology, Ibni Sina Hospital Central Microbiology LaboratoryAnkara University School of MedicineAnkara UniversityAnkaraTurkey
| | - Merve Aktar
- Department of Nephrology, Ankara University School of MedicineAnkara UniversityAnkaraTurkey
| | - Seda Şafak
- Department of Nephrology, Istanbul School of MedicineIstanbul UniversityIstanbulTurkey
| | - Ayşe Serra Artan
- Department of Nephrology, Istanbul School of MedicineIstanbul UniversityIstanbulTurkey
| | - Sevim Meşe
- Department of Medical Microbiology, Istanbul School of MedicineIstanbul UniversityIstanbulTurkey
| | - Ali Ağaçfidan
- Department of Medical Microbiology, Istanbul School of MedicineIstanbul UniversityIstanbulTurkey
| | - Güle Çınar
- Department of Infectious Diseases and Clinical MicrobiologyAnkara University School of MedicineAnkara UniversityAnkaraTurkey
| | - Mustafa Önel
- Department of Medical Microbiology, Istanbul School of MedicineIstanbul UniversityIstanbulTurkey
| | - Zeynep Ceren Karahan
- Department of Medical Microbiology, Ibni Sina Hospital Central Microbiology LaboratoryAnkara University School of MedicineAnkara UniversityAnkaraTurkey
| | - Şule Şengül
- Department of Nephrology, Ankara University School of MedicineAnkara UniversityAnkaraTurkey
| | - Kenan Keven
- Department of Nephrology, Ankara University School of MedicineAnkara UniversityAnkaraTurkey
| | - Aydın Türkmen
- Department of Nephrology, Istanbul School of MedicineIstanbul UniversityIstanbulTurkey
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95
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Timmermann L, Globke B, Lurje G, Schmelzle M, Schöning W, Öllinger R, Pratschke J, Eberspächer B, Drosten C, Hofmann J, Eurich D. Humoral Immune Response following SARS-CoV-2 Vaccination in Liver Transplant Recipients. Vaccines (Basel) 2021; 9:vaccines9121422. [PMID: 34960168 PMCID: PMC8703856 DOI: 10.3390/vaccines9121422] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/28/2021] [Accepted: 11/29/2021] [Indexed: 02/07/2023] Open
Abstract
As COVID-19 remains an issue in transplantation medicine, a successful vaccination can prevent infections and life-threatening courses. The probability of poor immune response in liver transplant recipients gained attention and insecurity among those patients, leading us to investigate the humoral immune response alongside the influence of underlying diseases and immunosuppressive regimen on seroconversion rates. We included 118 patients undergoing anti-spike-protein-IgG testing at least 21 days after completed SARS-CoV-2 vaccination. Ninety-seven patients also underwent anti-spike-protein-IgA testing. The influence of baseline demographics, immunosuppressive regimen and underlying disease on seroconversion was analyzed, and 92 of 118 patients (78.0%) developed anti-spike-protein-IgG antibodies. Patients with a history of alcoholic liver disease before transplantation showed significantly lower seroconversion rates (p = 0.006). Immunosuppression also significantly influenced antibody development (p < 0.001). Patients run on a mycophenolate mofetil (MMF)-based regimen were more likely not to develop antibodies compared to patients run on a non-MMF regimen (p < 0.001). All patients weaned off immunosuppression were seropositive. The seroconversion rate of 78.0% in our cohort of liver transplant recipients is promising. The identification of alcohol-induced cirrhosis as underlying disease and MMF for immunosuppression as risk factors for seronegativity may serve to identify vaccination non-responder after liver transplantation.
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Affiliation(s)
- Lea Timmermann
- Department of Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (B.G.); (G.L.); (M.S.); (W.S.); (R.Ö.); (J.P.); (D.E.)
- Correspondence: ; Tel.: +49-304-5055-2001
| | - Brigitta Globke
- Department of Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (B.G.); (G.L.); (M.S.); (W.S.); (R.Ö.); (J.P.); (D.E.)
| | - Georg Lurje
- Department of Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (B.G.); (G.L.); (M.S.); (W.S.); (R.Ö.); (J.P.); (D.E.)
| | - Moritz Schmelzle
- Department of Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (B.G.); (G.L.); (M.S.); (W.S.); (R.Ö.); (J.P.); (D.E.)
| | - Wenzel Schöning
- Department of Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (B.G.); (G.L.); (M.S.); (W.S.); (R.Ö.); (J.P.); (D.E.)
| | - Robert Öllinger
- Department of Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (B.G.); (G.L.); (M.S.); (W.S.); (R.Ö.); (J.P.); (D.E.)
| | - Johann Pratschke
- Department of Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (B.G.); (G.L.); (M.S.); (W.S.); (R.Ö.); (J.P.); (D.E.)
| | | | - Christian Drosten
- Department of Virology—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany;
| | - Jörg Hofmann
- Labor Berlin—Charité Vivantes GmbH, 13353 Berlin, Germany; (B.E.); (J.H.)
- Department of Virology—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany;
| | - Dennis Eurich
- Department of Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (B.G.); (G.L.); (M.S.); (W.S.); (R.Ö.); (J.P.); (D.E.)
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96
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Schmidt T, Klemis V, Schub D, Schneitler S, Reichert MC, Wilkens H, Sester U, Sester M, Mihm J. Cellular immunity predominates over humoral immunity after homologous and heterologous mRNA and vector-based COVID-19 vaccine regimens in solid organ transplant recipients. Am J Transplant 2021; 21:3990-4002. [PMID: 34453872 PMCID: PMC8652989 DOI: 10.1111/ajt.16818] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 01/25/2023]
Abstract
Knowledge on the immunogenicity of vector-based and mRNA-vaccines in solid organ transplant recipients is limited. Therefore, SARS-CoV-2-specific T cells and antibodies were analyzed in 40 transplant recipients and 70 controls after homologous or heterologous vaccine-regimens. Plasmablasts and SARS-CoV-2-specific CD4 and CD8 T cells were quantified using flow cytometry. Specific antibodies were analyzed by ELISA and neutralization assay. The two vaccine types differed after the first vaccination, as IgG and neutralizing activity were more pronounced after mRNA priming (p = .0001 each), whereas CD4 and CD8 T cell levels were higher after vector priming (p = .009; p = .0001). All regimens were well tolerated, and SARS-CoV-2-specific antibodies and/or T cells after second vaccination were induced in 100% of controls and 70.6% of transplant recipients. Although antibody and T cell levels were lower in patients, heterologous vaccination led to the most pronounced induction of antibodies and CD4 T cells. Plasmablast numbers were significantly higher in controls and correlated with SARS-CoV-2-specific IgG- and T cell levels. While antibodies were only detected in 35.3% of patients, cellular immunity was more frequently found (64.7%) indicating that assessment of antibodies is insufficient to identify COVID-19-vaccine responders. In conclusion, heterologous vaccination seems promising in transplant recipients, and combined analysis of humoral and cellular immunity improves the identification of responders among immunocompromised individuals.
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Affiliation(s)
- Tina Schmidt
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Verena Klemis
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - David Schub
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Sophie Schneitler
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | | | - Heinrike Wilkens
- Department of Internal Medicine V, Saarland University, Homburg, Germany
| | - Urban Sester
- Department of Internal Medicine IV, Saarland University, Homburg, Germany
| | - Martina Sester
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Janine Mihm
- Department of Internal Medicine IV, Saarland University, Homburg, Germany
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97
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Naruse H, Ito H, Izawa H, Sarai M, Ishii J, Sakaguchi E, Murakami R, Ando T, Fujigaki H, Saito K. Immunogenicity of BNT162b2 mRNA COVID-19 Vaccine in Patients with Cardiovascular Disease. J Clin Med 2021; 10:jcm10235498. [PMID: 34884205 PMCID: PMC8658500 DOI: 10.3390/jcm10235498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/20/2021] [Accepted: 11/22/2021] [Indexed: 01/14/2023] Open
Abstract
Concern has been raised about the effectiveness of the coronavirus disease 2019 (COVID-19) vaccine in the population of patients with various comorbidities such as heart disease. We investigated the humoral response to the BNT162b2 mRNA COVID-19 vaccine in patients with cardiovascular disease (CVD). We measured IgG against severe acute respiratory syndrome coronavirus 2 spike receptor-binding domain (RBD-IgG) in 85 CVD patients and 179 healthcare workers (HCWs). Blood samples were collected from patients and HCWs three times: (1) before the first dose of vaccination, (2) two weeks after the first dose of vaccination, and (3) two weeks after the second dose of vaccination. Patients with CVD showed a significantly inferior serological response to the BNT162b2 mRNA COVID-19 vaccine at 14 days after the prime dose compared to HCWs (21% vs. 95%, p < 0.001). Median RBD-IgG titers of patients with CVD at 14 days after the second dose were significantly lower than those of HCWs (137.2 U/mL (80.6-200.4 U/mL) vs. 176.2 U/mL (123.9-260.0 U/mL), p < 0.001). In multivariable analyses, CVD is significantly associated with seropositivity after first vaccination and RBD-IgG titers after second vaccination. CVD patients may have a poor humoral response to the BNT162b2 mRNA COVID-19 vaccine, need to be closely monitored, and require earlier revaccination to ensure stronger immunity and protection against infection.
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Affiliation(s)
- Hiroyuki Naruse
- Department of Clinical Pathophysiology, Fujita Health University Graduate School of Health Sciences, Toyoake 470-1192, Japan;
- Correspondence: ; Tel.: +81-562-93-2312; Fax: +81-562-93-2315
| | - Hiroyasu Ito
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine, Toyoake 470-1192, Japan; (H.I.); (R.M.); (T.A.)
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake 470-1192, Japan; (H.I.); (M.S.)
| | - Masayoshi Sarai
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake 470-1192, Japan; (H.I.); (M.S.)
| | - Junnichi Ishii
- Bantane Hospital, Fujita Health University School of Medicine, Nagoya 454-8509, Japan;
| | - Eirin Sakaguchi
- Department of Clinical Pathophysiology, Fujita Health University Graduate School of Health Sciences, Toyoake 470-1192, Japan;
| | - Reiko Murakami
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine, Toyoake 470-1192, Japan; (H.I.); (R.M.); (T.A.)
| | - Tatsuya Ando
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine, Toyoake 470-1192, Japan; (H.I.); (R.M.); (T.A.)
| | - Hidetsugu Fujigaki
- Department of Advanced Diagnostic System Development, Fujita Health University Graduate School of Health Sciences, Toyoake 470-1192, Japan; (H.F.); (K.S.)
| | - Kuniaki Saito
- Department of Advanced Diagnostic System Development, Fujita Health University Graduate School of Health Sciences, Toyoake 470-1192, Japan; (H.F.); (K.S.)
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98
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Discordance Between SARS-CoV-2-specific Cell-mediated and Antibody Responses Elicited by mRNA-1273 Vaccine in Kidney and Liver Transplant Recipients. Transplant Direct 2021; 7:e794. [PMID: 34805496 PMCID: PMC8601286 DOI: 10.1097/txd.0000000000001246] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/07/2021] [Accepted: 09/23/2021] [Indexed: 12/22/2022] Open
Abstract
Supplemental Digital Content is available in the text. Severe acute respiratory syndrome coronavirus 2–specific cell-mediated immunity (SARS-CoV-2-CMI) elicited by mRNA-based vaccines in solid organ transplant (SOT) recipients and its correlation with antibody responses remain poorly characterized.
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99
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Optimizing a Protocol to Assess Immune Responses after SARS-CoV-2 Vaccination in Kidney-Transplanted Patients: In Vivo DTH Cutaneous Test as the Initial Screening Method. Vaccines (Basel) 2021; 9:vaccines9111315. [PMID: 34835246 PMCID: PMC8620584 DOI: 10.3390/vaccines9111315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/04/2021] [Accepted: 11/06/2021] [Indexed: 01/14/2023] Open
Abstract
Previously, the delayed-type hypersensitivity (DTH) cutaneous test with the spike protein of SARS-CoV-2 has been shown to be a simple in vivo method to measure T-cell functionality after natural infection and in vaccinated individuals. Methods: Twenty-five kidney-transplanted recipients were immunized with two doses of the mRNA-based Pfizer–BioNTech COVID19 vaccine three weeks apart. Cell-immune response (CIR) was evaluated ten weeks later using an in vivo DTH skin test and in vitro with an interferon gamma release assay (IGRA). Humoral Immune Response (HIR) was determined by the measurement of specific IgG anti-S1 SARS-CoV-2. Results: Ten weeks after the second dose of the vaccine, 23 out of 25 transplanted patients had a positive DTH skin test, while in vitro CIR was considered positive in 20 patients. Unspecific stimulation was positive in all 25 patients, showing no T-cell defect. Seven out of twenty-five patients had a negative specific anti-spike IgG. CIR was positive in all immune-competent control patients. Conclusions: DTH is a useful, simple, and cheaper tool that can be used to assess cellular immune response, with an excellent correlation with the in vitro CIR. CIR assessment after vaccination in these immunocompromised patients is an excellent complement to HIR-based methods. This skin test could be used if classical in vitro methods cannot be applied.
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100
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Dougall A, Molina G, Mac Giolla Phadraig C. Covid-19 vaccination among people with disability-Statement from the iADH scientific committee. SPECIAL CARE IN DENTISTRY 2021; 41:655-657. [PMID: 34652828 PMCID: PMC8661773 DOI: 10.1111/scd.12667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 09/29/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Alison Dougall
- Department of Public and Child Dental Health, International Association for Disability and Oral Health, Dublin Dental University Hospital and Trinity College Dublin, Dublin, Ireland
| | - Gustavo Molina
- Department of Special Care Dentistry, International Association for Disability and Oral Health, The Dental School, Universidad Católica de Córdoba, Córdoba, Argentina
| | - Caoimhin Mac Giolla Phadraig
- Department of Public and Child Dental Health, International Association for Disability and Oral Health, Dublin Dental University Hospital and Trinity College Dublin, Dublin, Ireland
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