TY - JOUR
T1 - Impact of tozinameran (BNT162b2) mRNA vaccine on kidney transplant and chronic dialysis patients
T2 - 3–5 months follow-up
AU - Ben-Dov, Iddo Z.
AU - Oster, Yonatan
AU - Tzukert, Keren
AU - Alster, Talia
AU - Bader, Raneem
AU - Israeli, Ruth
AU - Asayag, Haya
AU - Aharon, Michal
AU - Burstein, Ido
AU - Pri-Chen, Hadas
AU - Imam, Ashraf
AU - Abel, Roy
AU - Mor-Yosef Levi, Irit
AU - Khalaileh, Abed
AU - Oiknine-Djian, Esther
AU - Bloch, Aharon
AU - Wolf, Dana G.
AU - Dranitzki Elhalel, Michal
N1 - Publisher Copyright:
© 2021, The Author(s) under exclusive licence to Italian Society of Nephrology.
PY - 2022/1
Y1 - 2022/1
N2 - 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. Graphic abstract: [Figure not available: see fulltext.].
AB - 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. Graphic abstract: [Figure not available: see fulltext.].
KW - COVID-19
KW - End-stage renal disease
KW - Hemodialysis
KW - Kidney transplantation
KW - Peritoneal dialysis
KW - Vaccines
KW - Viral infections
UR - http://www.scopus.com/inward/record.url?scp=85122291574&partnerID=8YFLogxK
U2 - 10.1007/s40620-021-01210-y
DO - 10.1007/s40620-021-01210-y
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C2 - 34988942
AN - SCOPUS:85122291574
SN - 1121-8428
VL - 35
SP - 153
EP - 164
JO - Journal of Nephrology
JF - Journal of Nephrology
IS - 1
ER -
