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. 2021 Sep;32(9):2147-2152.
doi: 10.1681/ASN.2021040480. Epub 2021 Jun 10.

Antibody and T Cell Response to SARS-CoV-2 Messenger RNA BNT162b2 Vaccine in Kidney Transplant Recipients and Hemodialysis Patients

Dominique Bertrand  1 , Mouad Hamzaoui  1 , Veronique Lemée  2 , Julie Lamulle  3 , Mélanie Hanoy  1 , Charlotte Laurent  1 , Ludivine Lebourg  1 , Isabelle Etienne  1 , Mathilde Lemoine  1 , Frank Le Roy  1 , Dorian Nezam  1 , Jean-Christophe Plantier  2 , Olivier Boyer  3   4 , Dominique Guerrot  1 , Sophie Candon  3   4
Affiliations

Antibody and T Cell Response to SARS-CoV-2 Messenger RNA BNT162b2 Vaccine in Kidney Transplant Recipients and Hemodialysis Patients

Dominique Bertrand et al. J Am Soc Nephrol. 2021 Sep.

Abstract

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with a high rate of mortality in patients with ESKD, and vaccination is hoped to prevent infection.

Methods: Between January 18 and February 24, 2021, 225 kidney transplant recipients (KTRs) and 45 patients on hemodialysis (HDPs) received two injections of mRNA BNT162b2 vaccine. The postvaccinal humoral and cellular response was explored in the first 45 KTRs and ten HDPs.

Results: After the second dose, eight HDPs (88.9%) and eight KTRs (17.8%) developed antispike SARS-CoV-2 antibodies (P<0.001). Median titers of antibodies in responders were 1052 AU/ml (IQR, 515-2689) in HDPs and 671 AU/ml (IQR, 172-1523) in KTRs (P=0.40). Nine HDPs (100%) and 26 KTRs (57.8%) showed a specific T cell response (P=0.06) after the second injection. In responders, median numbers of spike-reactive T cells were 305 SFCs per 106 CD3+ T cells (IQR, 95-947) in HDPs and 212 SFCs per 106 CD3+ T cells (IQR, 61-330) in KTRs (P=0.40). In KTRs, the immune response to BNT162b2 seemed influenced by the immunosuppressive regimen, particularly tacrolimus or belatacept.

Conclusion: Immunization with BNT162b2 seems more efficient in HDPs, indicating that vaccination should be highly recommended in these patients awaiting a transplant. However, the current vaccinal strategy for KTRs may not provide effective protection against COVID-19 and will likely need to be improved.

Keywords: COVID-19; clinical immunology; hemodialysis; kidney transplantation.

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Figures

None
Graphical abstract
Figure 1.
Figure 1.
(A) SARS-CoV-2 antispike antibody response and (B) SARS-CoV-2–reactive IFNγ-producing T cells in KTRs and patients on hemodialysis (HDPs) following the first and second injections of the SARS-CoV-2 mRNA BNT162b2 vaccine. Titers of S IgG are shown in the samplings of 45 KTRs and nine HDPs. Medians and IQRs are shown. Numbers of T cells (expressed as SFCs per 106 CD3+ T cells) reactive to overlapping peptide pools spanning SARS-CoV-2 structural protein S (pools S1 and S2) in 45 KTR and nine HDPs are shown. Medians and IQRs are shown. UA, arbitrary units.
Figure 2.
Figure 2.
(A) SARS-CoV-2 antispike antibody response and (B) SARS-CoV-2–reactive IFNγ-producing T cells in KTRs following the first and second injections of the SARS-CoV-2 mRNA BNT162b2 vaccine according to the immunosuppressive regimen. Numbers of T cells (expressed as SFCs per 106 CD3+ T cells) reactive to overlapping peptide pools spanning SARS-CoV-2 structural protein S (pools S1and S2) in the samplings of 45 KTRs are shown. Median and IQR are shown. Bela, belatacept; Tac, tacrolimus. UA, arbitrary units.
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References

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