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Urra JM, Castro P, Jiménez N, Moral E, Vozmediano C. Partial recovery of SARS-CoV-2 immunity after booster vaccination in renal transplant recipients. CLINICAL IMMUNOLOGY COMMUNICATIONS 2023; 3:1-5. [PMID: 38014395 PMCID: PMC9741556 DOI: 10.1016/j.clicom.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 11/24/2022] [Accepted: 12/10/2022] [Indexed: 12/14/2022]
Abstract
The pandemic caused by the SARS-CoV-2 coronavirus has been especially detrimental to patients with end-stage renal disease. History with other vaccines suggests that patients with renal disease may not respond adequately to the SARS-CoV-2 vaccine. The aim of this study is to evaluate the immunity to SARS-CoV-2 mRNA vaccines in renal patients. Post SARS-CoV-2 vaccination first, and after the booster dose, antibodies and cellular immunity were studied in patients on hemodialysis (N = 20), peritoneal dialysis (N = 10) and renal transplantation (N = 10). After the two doses of vaccine, there was an effective immunity in dialysis patients, with 100% seroconversion and 87% detection of cellular immunity (85% in hemodialysis and 90% in peritoneal dialysis). In contrast, in renal transplant recipients there was only 50% seroconversion and cellular immunity was detected in 30% of patients. After the booster dose, all dialysis patients achieved a cellular and antibody immunity, whereas in transplant patients, despite improvement, 20% did not produce antibodies and in 37.5% cellular immunity could not be detected. The mRNA vaccine plus booster performs excellently in dialysis patients, whereas in kidney transplant recipients, despite the booster, complete immunization is not achieved.
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Affiliation(s)
- J M Urra
- Immunology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
- Facultad de Medicina de Ciudad Real, Universidad de Castilla La Mancha (UCLM), Spain
| | - P Castro
- Nephrology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - N Jiménez
- Immunology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - E Moral
- Nephrology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - C Vozmediano
- Facultad de Medicina de Ciudad Real, Universidad de Castilla La Mancha (UCLM), Spain
- Nephrology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
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Rossi M, Pessolano G, Gambaro G. What has vaccination against COVID-19 in CKD patients taught us? J Nephrol 2023; 36:1257-1266. [PMID: 37140817 PMCID: PMC10157569 DOI: 10.1007/s40620-023-01640-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 05/05/2023]
Abstract
Effective vaccination strategies are of crucial importance to protecting patients who are vulnerable to infections, such as patients with chronic kidney disease. This is because the decreased efficiency of the immune system in chronic kidney disease impairs vaccine-induced immunisation. COVID-19 has prompted investigation of the immune response to SARS-CoV-2 vaccines in chronic kidney disease and in kidney transplant recipients in an effort to improve efficacy. The seroconversion rate after two vaccine doses is reduced, especially in kidney transplant recipients. Furthermore, although the seroconversion rate in chronic kidney disease patients is as high as in healthy subjects, anti-spike antibody titres are lower than in healthy vaccinated individuals, and these titres decrease rapidly. Although the vaccine-induced anti-spike antibody titre correlates with neutralising antibody levels and with protection against COVID-19, the protective prognostic significance of their titre is decreased due to the emergence of SARS-CoV-2 variants other than the Wuhan index virus against which the original vaccines were produced. Cellular immunity is also relevant, and because of cross-reactivity to the spike protein, epitopes of different viral variants confer protection against newly emerging variants of SARS-CoV-2. A multi-dose vaccination strategy is the most effective way to obtain a sufficient serological response. In kidney transplant recipients, a 5-week discontinuation period from antimetabolite drugs in concomitance with vaccine administration may also increase the vaccine's efficacy. The newly acquired knowledge obtained from COVID-19 vaccination is of general interest for the success of other vaccinations in chronic kidney disease patients.
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Affiliation(s)
- Mattia Rossi
- Division of Nephrology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy.
| | - Giuseppina Pessolano
- Division of Nephrology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Giovanni Gambaro
- Division of Nephrology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
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Puspitasari M, Sattwika PD, Hidayat ARP, Wijaya W, Wardhani Y, Intansari US, Kertia N, Purwanto B, Thobari JA. Immunogenicity and safety of COVID-19 BNT162b2 booster vaccine in end-stage kidney disease patients receiving haemodialysis in Yogyakarta, Indonesia: a cohort prospective study. BMC Nephrol 2023; 24:151. [PMID: 37248445 DOI: 10.1186/s12882-023-03218-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/25/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND A significant decrease in antibody titres several months after COVID-19 primary vaccination in end-stage kidney disease (ESKD) patients receiving maintenance haemodialysis has recently been reported. The waning in antibody titres has led to the recommendations for a booster dose to increase the antibody titres after vaccination. Consequently, it is crucial to analyse the long-term humoral immune responses after COVID-19 primary vaccination and assess the immunogenicity and safety of booster doses in haemodialysis (HD) patients. METHODS Patients on maintenance haemodialysis who received the primary vaccine of CoronaVac (Sinovac) vaccine were administered with BNT162b2 (Pfizer-BioNTech) as the booster dose. The immunogenicity was assessed before (V1), one month (V2) and eight months (V3) after the primary vaccination, as well as one month after the booster dose (V4). Patients were followed up one month after the booster dose to assess the adverse events (AEs). RESULTS The geometric mean titre (GMT) of anti-SARS-CoV-2 S-RBD IgG antibody at 8 months after the primary vaccination increased significantly to 5,296.63 (95%CI: 2,930.89-9,571.94) U/mL (p = < 0.0001) compared to before the primary vaccination. The GMT also increased significantly to 19,142.56 (95% CI: 13,489.63-27,227.01) U/mL (p < 0.0001) 1 month after the booster vaccine. Meanwhile, the median inhibition rate of neutralizing antibodies (NAbs) at 8 months after the primary vaccine and 1 month after the booster dose were not significantly different (p > 0.9999). The most common AEs after the booster dose included mild pain at the injection site (55.26%), mild fatigue (10.53%), and swelling at the injection site (10.53%). No serious AEs were reported. CONCLUSIONS The majority of ESKD patients on haemodialysis mounted a good antibody response to the BNT162b2 booster vaccination with tolerable adverse events.
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Affiliation(s)
- Metalia Puspitasari
- Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia.
| | - Prenali D Sattwika
- Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
- Clinical Epidemiology and Biostatistics Unit, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
- Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Auliana R P Hidayat
- Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Wynne Wijaya
- Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Yulia Wardhani
- Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Umi S Intansari
- Department of Clinical Pathology and Laboratory Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Nyoman Kertia
- Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Bambang Purwanto
- Department of Internal Medicine, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Jarir At Thobari
- Clinical Epidemiology and Biostatistics Unit, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
- Department of Pharmacology and Therapy, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Taheri S. Efficacy and safety of booster vaccination against SARS-CoV-2 in dialysis and renal transplant patients: systematic review and meta-analysis. Int Urol Nephrol 2023; 55:791-802. [PMID: 36723829 PMCID: PMC9890430 DOI: 10.1007/s11255-023-03471-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/16/2023] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Patients under renal replacement therapy are at an increased risk of severe infection with SARS-CoV-2, and have been known to have impaired response to standard vaccination. This systematic review and meta-analysis aims at evaluating the efficacy of booster dose vaccination in this population. METHODS A systematic review has been conducted to find trials on the booster dose vaccination in kidney transplant recipients (KTRs) or patients under dialysis. Data of seroconversion rates at different timepoints, especially 1 month prior and post-booster dose vaccination have been collected and analyzed. Effects of different factors including type of renal replacement therapy (RRT), vaccine type and brands, magnitude of response to the standard vaccination, and immunosuppression drugs on the response rates have been investigated. Meta-analyses were performed using software Stata v.17. RESULTS Overall 58 studies were included. Both RRT patient subgroups represented significant seroconversion, post- (versus pre-) booster dose vaccination, but only in KTRs the booster dose seroconversion surpassed that of the standard protocol. T-cell response was also significantly augmented after booster vaccination, with no difference between the RRT subgroups. mRNA and vector vaccine types had comparable immunogenicity when employed as boosters, both significantly higher than the inactivated virus vaccine, with no significant disparity regarding the vaccine brands. Patients with poor response to standard vaccination had a significant response to booster dose, with dialysis patients having stronger response. The differential effects of vaccine types and brands in the poor responders was similar to that of the overall RRT population. No rejection episodes or graft failure post-booster vaccination was reported. CONCLUSION In patients under RRT, booster dose vaccination against SARS-CoV-2 is safe and efficacious determined by significant seroconversion, and therefore, it should be considered to be implemented in all these patients. Since in the KTR patients, the third dose vaccination significantly increased the seroconversion rates even beyond that of the standard protocol, three dose vaccine doses is recommended to be recognized as the standard vaccination protocol in this population. The same recommendation could be considered for dialysis patients, due to their augmented risk of breakthrough infection.
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Affiliation(s)
- Saeed Taheri
- New Lahijan Scientific Foundation, Lahijan, Iran.
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Mirioglu S, Kazancioglu R, Cebeci E, Eren N, Sakaci T, Alagoz S, Tugcu M, Tuglular S, Sumbul B, Seyahi N, Ozturk S. Humoral Response to BNT162b2 and CoronaVac in Patients Undergoing Maintenance Hemodialysis: A Multicenter Prospective Cohort Study. Nephron Clin Pract 2023; 147:392-400. [PMID: 36603567 PMCID: PMC9843732 DOI: 10.1159/000528170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 10/11/2022] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Data regarding inactivated vaccines for SARS-CoV-2 in patients undergoing maintenance hemodialysis (MHD) are limited. We aimed to investigate humoral responses induced by CoronaVac compared to BNT162b2 in this population. METHODS In this multicenter prospective cohort study, adult patients undergoing MHD who lacked a history of COVID-19 and decided to get vaccinated with BNT162b2 or CoronaVac were enrolled. Participants provided serum samples before, 1 and 3 months after 2 doses. Anti-SARS-CoV-2 IgG antibodies against receptor-binding domain of the virus were measured, and levels ≥50 AU/mL were considered as positive. Breakthrough infections and adverse events were recorded. RESULTS Ninety-two patients were included, 68 (73.9%) of whom were seronegative at baseline. BNT162b2 and CoronaVac were administered in 38 (55.9%) and 30 (44.1%) patients. At 1 month, seropositivity was 93.1% in BNT162b2 and 88% in CoronaVac groups (p = 0.519). Quantitative antibody levels were significantly higher in BNT162b2 (p < 0.001). At 3 months, both seropositivity (96.4% and 78.3%, p = 0.045) and antibody levels (p = 0.001) remained higher in BNT162b2 compared to CoronaVac. Five patients (7.4%) experienced breakthrough COVID-19. Adverse events were more frequent with BNT162b2, although all of them were mild. Multiple linear regression model showed that only vaccine choice (BNT162b2) was related to the humoral response (β = 0.272, p = 0.038). Seropositive patients at baseline (n = 24) had higher antibody levels at any time point. CONCLUSIONS BNT162b2 and CoronaVac induced humoral responses in naïve patients undergoing MHD, which were more robust and durable for 3 months after BNT162b2. Both vaccines created high antibody levels in patients who were seropositive at baseline.
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Affiliation(s)
- Safak Mirioglu
- Division of Nephrology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey,
| | - Rumeyza Kazancioglu
- Division of Nephrology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Egemen Cebeci
- Division of Nephrology, Istanbul Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Necmi Eren
- Division of Nephrology, Kocaeli University School of Medicine, İzmit, Turkey
| | - Tamer Sakaci
- Division of Nephrology, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Selma Alagoz
- Division of Nephrology, Istanbul Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Murat Tugcu
- Division of Nephrology, Marmara University School of Medicine, Istanbul, Turkey
| | - Serhan Tuglular
- Division of Nephrology, Marmara University School of Medicine, Istanbul, Turkey
| | - Bilge Sumbul
- Department of Medical Microbiology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Nurhan Seyahi
- Division of Nephrology, Istanbul University-Cerrahpasa Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Savas Ozturk
- Division of Nephrology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
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