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. 2021 Aug;21(8):2727-2739.
doi: 10.1111/ajt.16701. Epub 2021 Aug 4.

Cellular and humoral response after MRNA-1273 SARS-CoV-2 vaccine in kidney transplant recipients

David Cucchiari  1   2 , Natalia Egri  3 , Marta Bodro  4 , Sabina Herrera  4 , Jimena Del Risco-Zevallos  1 , Joaquim Casals-Urquiza  1 , Frederic Cofan  1 , Asunción Moreno  4 , Jordi Rovira  2   5 , Elisenda Banon-Maneus  2   5 , Maria J Ramirez-Bajo  2   5 , Pedro Ventura-Aguiar  1   2 , Anna Pérez-Olmos  1 , Marta Garcia-Pascual  1 , Mariona Pascal  3   6   7 , Anna Vilella  8 , Antoni Trilla  8 , José Ríos  9   10 , Eduard Palou  3 , Manel Juan  3 , Beatriu Bayés  1 , Fritz Diekmann  1   2   5
Affiliations

Cellular and humoral response after MRNA-1273 SARS-CoV-2 vaccine in kidney transplant recipients

David Cucchiari et al. Am J Transplant. 2021 Aug.

Abstract

According to preliminary data, seroconversion after mRNA SARS-CoV-2 vaccination might be unsatisfactory in Kidney Transplant Recipients (KTRs). However, it is unknown if seronegative patients develop at least a cellular response that could offer a certain grade of protection against SARS-CoV-2. To answer this question, we prospectively studied 148 recipients of either kidney (133) or kidney-pancreas (15) grafts with assessment of IgM/IgG spike (S) antibodies and ELISpot against the nucleocapside (N) and the S protein at baseline and 2 weeks after receiving the second dose of the mRNA-1273 (Moderna) vaccine. At baseline, 31 patients (20.9%) had either IgM/IgG or ELISpot positivity and were considered to be SARS-CoV-2-pre-immunized, while 117 (79.1%) patients had no signs of either cellular or humoral response and were considered SARS-CoV-2-naïve. After vaccination, naïve patients who developed either humoral or cellular response were finally 65.0%, of which 29.9% developed either IgG or IgM and 35.0% S-ELISpot positivity. Factors associated with vaccine unresponsiveness were diabetes and treatment with antithymocytes globulins during the last year. Side effects were consistent with that of the pivotal trial and no DSAs developed after vaccination. In conclusion, mRNA-1273 SARS-CoV-2 vaccine elicits either cellular or humoral response in almost two thirds of KTRs.

Keywords: clinical research / practice; infection and infectious agents - viral; infectious disease; kidney transplantation / nephrology; vaccine.

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Figures

FIGURE 1
FIGURE 1
Study population according to the baseline status. Patients are highlighted in red if they had evidence of previous immunization against SARS-CoV-2 and in blue in the absence of previous immunization
FIGURE 2
FIGURE 2
Development of humoral and cellular response in SARS-CoV-2-naïve patients after administration of the mRNA-1273 vaccine. Patients are highlighted in green according to the development or either antibodies or S-ELISpot positivity, identifying vaccine responders. Patients without response to the vaccine are highlighted in red
FIGURE 3
FIGURE 3
Changes in IgM and IgG concentration (A,B), N-ELISpot (C), and S-ELISpot (D) before and after vaccination with mRNA-1273 SARS-CoV-2 vaccine. Changes in the IgG titer in patients who were IgG(+) at baseline (E). Differences are analyzed by means of the Mann-Whitney test between groups and of the Wilcoxon signed-rank test for related samples within the same group along different time-points and an asterisk (*) identifies statistical significance. Bars identify medians. The Y-axis in Figure 3A–D is 10-logarithmic based, so patients with “0” SFU/2x105 PBMCs are not displayed
FIGURE 4
FIGURE 4
Side effects reported by patients after receiving the two doses of the mRNA-1273 SARS-CoV-2 vaccine
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