TY - JOUR
T1 - Humoral and cellular immunity to SARS-CoV-2 vaccination in renal transplant versus dialysis patients
T2 - A prospective, multicenter observational study using mRNA-1273 or BNT162b2 mRNA vaccine
AU - Stumpf, Julian
AU - Siepmann, Torsten
AU - Lindner, Tom
AU - Karger, Claudia
AU - Schwöbel, Jörg
AU - Anders, Leona
AU - Faulhaber-Walter, Robert
AU - Schewe, Jens
AU - Martin, Heike
AU - Schirutschke, Holger
AU - Barnett, Kerstin
AU - Hüther, Jan
AU - Müller, Petra
AU - Langer, Torsten
AU - Pluntke, Thilo
AU - Anding-Rost, Kirsten
AU - Meistring, Frank
AU - Stehr, Thomas
AU - Pietzonka, Annegret
AU - Escher, Katja
AU - Cerny, Simon
AU - Rothe, Hansjörg
AU - Pistrosch, Frank
AU - Seidel, Harald
AU - Paliege, Alexander
AU - Beige, Joachim
AU - Bast, Ingolf
AU - Steglich, Anne
AU - Gembardt, Florian
AU - Kessel, Friederike
AU - Kröger, Hannah
AU - Arndt, Patrick
AU - Sradnick, Jan
AU - Frank, Kerstin
AU - Klimova, Anna
AU - Mauer, René
AU - Grählert, Xina
AU - Anft, Moritz
AU - Blazquez-Navarro, Arturo
AU - Westhoff, Timm H.
AU - Stervbo, Ulrik
AU - Tonn, Torsten
AU - Babel, Nina
AU - Hugo, Christian
N1 - Publisher Copyright:
© 2021 The Authors
PY - 2021/10
Y1 - 2021/10
N2 - Background: Dialysis and kidney transplant patients are vulnerable populations for COVID-19 related disease and mortality. Methods: We conducted a prospective study exploring the eight week time course of specific cellular (interferon-γ release assay and flow cytometry) or/and humoral immune responses (ELISA) to SARS-CoV-2 boost vaccination in more than 3100 participants including medical personnel, dialysis patients and kidney transplant recipients using mRNA vaccines BNT162b2 or mRNA-1273. Results: SARS-CoV-2-vaccination induced seroconversion efficacy in dialysis patients was similar to medical personnel (> 95%), but markedly impaired in kidney transplant recipients (42%). T-cellular immunity largely mimicked humoral results. Major risk factors of seroconversion failure were immunosuppressive drug number and type (belatacept, MMF-MPA, calcineurin-inhibitors) as well as vaccine type (BNT162b2 mRNA). Seroconversion rates induced by mRNA-1273 compared to BNT162b2 vaccine were 97% to 88% (p < 0.001) in dialysis and 49% to 26% in transplant patients, respectively. Specific IgG directed against the new binding domain of the spike protein (RDB) were significantly higher in dialysis patients vaccinated by mRNA-1273 (95%) compared to BNT162b2 (85%, p < 0.001). Vaccination appeared safe and highly effective demonstrating an almost complete lack of symptomatic COVID-19 disease after boost vaccination as well as ceased disease incidences during third pandemic wave in dialysis patients. Conclusion: Dialysis patients exhibit a remarkably high seroconversion rate of 95% after boost vaccination, while humoral response is impaired in the majority of transplant recipients. Immunosuppressive drug number and type as well as vaccine type (BNT162b2) are major determinants of seroconversion failure in both dialysis and transplant patients suggesting immune monitoring and adaption of vaccination protocols.
AB - Background: Dialysis and kidney transplant patients are vulnerable populations for COVID-19 related disease and mortality. Methods: We conducted a prospective study exploring the eight week time course of specific cellular (interferon-γ release assay and flow cytometry) or/and humoral immune responses (ELISA) to SARS-CoV-2 boost vaccination in more than 3100 participants including medical personnel, dialysis patients and kidney transplant recipients using mRNA vaccines BNT162b2 or mRNA-1273. Results: SARS-CoV-2-vaccination induced seroconversion efficacy in dialysis patients was similar to medical personnel (> 95%), but markedly impaired in kidney transplant recipients (42%). T-cellular immunity largely mimicked humoral results. Major risk factors of seroconversion failure were immunosuppressive drug number and type (belatacept, MMF-MPA, calcineurin-inhibitors) as well as vaccine type (BNT162b2 mRNA). Seroconversion rates induced by mRNA-1273 compared to BNT162b2 vaccine were 97% to 88% (p < 0.001) in dialysis and 49% to 26% in transplant patients, respectively. Specific IgG directed against the new binding domain of the spike protein (RDB) were significantly higher in dialysis patients vaccinated by mRNA-1273 (95%) compared to BNT162b2 (85%, p < 0.001). Vaccination appeared safe and highly effective demonstrating an almost complete lack of symptomatic COVID-19 disease after boost vaccination as well as ceased disease incidences during third pandemic wave in dialysis patients. Conclusion: Dialysis patients exhibit a remarkably high seroconversion rate of 95% after boost vaccination, while humoral response is impaired in the majority of transplant recipients. Immunosuppressive drug number and type as well as vaccine type (BNT162b2) are major determinants of seroconversion failure in both dialysis and transplant patients suggesting immune monitoring and adaption of vaccination protocols.
KW - BNT162b2
KW - COVID-19
KW - SARS-CoV-2 vaccination
KW - clinical decision-making
KW - dialysis patients
KW - epidemiology
KW - guidelines
KW - humoral and cellular immune response
KW - kidney transplant recipients
KW - mRNA-1273
KW - medical personnel
KW - tozinameran
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U2 - 10.1016/j.lanepe.2021.100178
DO - 10.1016/j.lanepe.2021.100178
M3 - Article
C2 - 34318288
AN - SCOPUS:85111051345
SN - 2666-7762
VL - 9
JO - The Lancet Regional Health - Europe
JF - The Lancet Regional Health - Europe
M1 - 100178
ER -
