Third COVID-19 Vaccine Dose May Prompt Response in Transplant Recipients
WEDNESDAY, July 28, 2021 -- A third dose of the mRNA-1273 vaccine induces a serologic response in 49 percent of kidney transplant recipients who did not respond after receiving two doses, according to a research letter published online July 23 in...
Nefrologia. 2021 Aug 27:S0211-6995(21)00174-0. doi: 10.1016/j.nefro.2021.07.012. Online ahead of print.NO ABSTRACTPMID:34556352 | DOI:10.1016/j.nefro.2021.07.012
Transpl Immunol. 2021 Sep 15:101469. doi: 10.1016/j.trim.2021.101469. Online ahead of print.NO ABSTRACTPMID:34536553 | PMC:PMC8443310 | DOI:10.1016/j.trim.2021.101469
Coronavirus disease 2019 (COVID-19) –vaccinated kidney transplant recipients (KTRs) display a lower-than-normal antibody (Ab) response toward severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), indicating a reduced humoral immune response against the virus.1 A remaining question is to which extent this translates to lower the ability of KTRs to combat SARS-CoV-2.2 This capacity can be estimated by surrogate or pseudovirus neutralization assays or, optimally, the plaque reduction neutralization test (PRNT), in which live SARS-CoV-2 is challenged directly with patient blood plasma.
COVID-19 vaccinated kidney transplant recipients (KTRs) display a lower-than-normal antibody (Ab) response towards SARS-CoV-2, indicating a reduced humoral immune response against the virus . A remaining question is to which extend this translates to lower ability of KTRs to combat SARS-COV-2 . This capacity can be estimated by surrogate or pseudovirus neutralization assays or, optimally, the plaque reduction neutralization test (PRNT) in which live SARS-COV-2 is challenged directly with patient blood plasma [3, 4].
ConclusionOur results suggest vaccine response in adolescent KRT is lower than that of the general population, but similar to that previously described in adult SOT patients and slightly better than that seen in adult KTR. This data demonstrates vaccination is safe and supports immunizing KTR who remain hesitant. Future studies should focus on better understanding of the cellular immune response to vaccination and strategies to enhance vaccine immunogenicity in pediatric SOT patients.Graphical abstract
Renal transplant recipients (RTR) are at high risk for fatal Coronavirus disease 2019 (COVID-19) . Vaccinations are indispensable to protect this vulnerable population. Unfortunately,>50% of solid organ recipients do not mount antibody responses after two doses of SARS-CoV-2-mRNA vaccines [2,3]. We hypothesized that a third vaccine dose elicits protective humoral and cellular immune response in primary non-responders. Ten RTR under immunosuppression (Suppl. Table 1) without measurable SARS-CoV-2 spike antibodies 4 weeks after a second dose of BNT162b2, received a third vaccine dose (mRNA-1273), which was well tolerated.
We describe the case of a 30-year-old male kidney transplant recipient from Wuhan, China that was treated for severe COVID-19 in February 2020. He suffered an acute lung and renal injury and required systemic treatment including adjustment of his immunosuppressant regime. He was followed up to 1-year after discharge. No chronic lung fibrosis or deterioration of his pulmonary function was observed. Despite COVID-19 mediated damage to his renal tubular cells, no transplant rejection occurred. His immunological profile demonstrated both cellular anti-SARS-CoV-2 reactivity and specific humoral immunity, indicating that it is b...
The advent of vaccines has resulted in mitigation of severe disease as a consequence of SARS-CoV-2. There is notable absence of humoral absence after two doses of mRNA vaccines in rheumatic and musculoskeletal diseases. 1 There has been evidence that administration of third dose of vaccine leads to augmentation of humoral response in kidney transplant recipients. 2 In addition, there is increasing evidence that neutralizing antibody titers correlate with reduction in breakthrough infections in vaccinated individuals.
The case fatality ratio of COVID-19 in kidney transplant recipients (KTR) is between 10-30%1,2, underscoring the importance of vaccination to prevent COVID-19. However, KTR have a reduced response to COVID-19 vaccines (18%-54%)3,4. We determined SARS-CoV-2 spike IgG (anti-spike IgG) responses to COVID-19 vaccination in 65 KTRs who received BNT162b2, 29 who received mRNA-1273, and 4 who received Janssen Ad26.CoV2.S vaccines at a median of 4 years (range, 3 months-22 years) after transplantation (supplemental table and files).