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. 2022 May 4;11(9):2565.
doi: 10.3390/jcm11092565.

Serological Response to Three, Four and Five Doses of SARS-CoV-2 Vaccine in Kidney Transplant Recipients

Bilgin Osmanodja  1 , Simon Ronicke  1 , Klemens Budde  1 , Annika Jens  1 , Charlotte Hammett  1 , Nadine Koch  1 , Evelyn Seelow  1 , Johannes Waiser  1 , Bianca Zukunft  1 , Friederike Bachmann  1 , Mira Choi  1 , Ulrike Weber  1 , Bettina Eberspächer  2 , Jörg Hofmann  2 , Fritz Grunow  1 , Michael Mikhailov  1 , Lutz Liefeldt  1 , Kai-Uwe Eckardt  1 , Fabian Halleck  1 , Eva Schrezenmeier  1   3
Affiliations

Serological Response to Three, Four and Five Doses of SARS-CoV-2 Vaccine in Kidney Transplant Recipients

Bilgin Osmanodja et al. J Clin Med. .

Abstract

Mortality from COVID-19 among kidney transplant recipients (KTR) is high, and their response to three vaccinations against SARS-CoV-2 is strongly impaired. We retrospectively analyzed the serological response of up to five doses of the SARS-CoV-2 vaccine in KTR from 27 December 2020 until 31 December 2021. Particularly, the influence of the different dose adjustment regimens for mycophenolic acid (MPA) on serological response to fourth vaccination was analyzed. In total, 4277 vaccinations against SARS-CoV-2 in 1478 patients were analyzed. Serological response was 19.5% after 1203 basic immunizations, and increased to 29.4%, 55.6%, and 57.5% in response to 603 third, 250 fourth, and 40 fifth vaccinations, resulting in a cumulative response rate of 88.7%. In patients with calcineurin inhibitor and MPA maintenance immunosuppression, pausing MPA and adding 5 mg prednisolone equivalent before the fourth vaccination increased the serological response rate to 75% in comparison to the no dose adjustment (52%) or dose reduction (46%). Belatacept-treated patients had a response rate of 8.7% (4/46) after three vaccinations and 12.5% (3/25) after four vaccinations. Except for belatacept-treated patients, repeated SARS-CoV-2 vaccination of up to five times effectively induces serological response in kidney transplant recipients. It can be enhanced by pausing MPA at the time of vaccination.

Keywords: COVID-19; immunosuppression; kidney transplantation; vaccination.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient flow diagram showing the number of patients included into each analysis and the number of excluded patients and the respective reasons for exclusion.
Figure 2
Figure 2
(A) Serological response rate (±standard deviation) per vaccination after basic immunization, three, four, and five doses of SARS-CoV-2 vaccines in kidney transplant recipients without sufficient serological response before the latest vaccination. (B) Cumulative serological response rate (±95% confidence interval) after up to five doses of SARS-CoV-2 vaccines in all kidney transplant recipients with at least one vaccination meeting the inclusion and exclusion criteria.
Figure 3
Figure 3
Serological response rates after four doses of SARS-CoV-2 vaccines in kidney transplant recipients with steady MPA dose (n = 33), reduced MPA dose (n = 63), and paused MPA (n = 103). * adjusted p < 0.05, *** adjusted p < 0.001.
Figure 4
Figure 4
(A) Serological response rate per vaccination (±standard deviation) and (B) cumulative serological response rate (± 95% confidence interval) after up to 5 vaccinations in patients with CNI-based immunosuppression, as well as (C) serological response rate per vaccination (±standard deviation) and (D) cumulative serological response rate (±95% confidence interval) after up to 4 vaccinations in patients with belatacept-based immunosuppression. Cumulative response rate after fifth vaccination is not shown for patients with belatacept, due to low patient count of 5 patients receiving fifth vaccination.
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