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Observational Study
. 2022 Sep 2;14(9):1951.
doi: 10.3390/v14091951.

Serological Response and Clinical Protection of Anti-SARS-CoV-2 Vaccination and the Role of Immunosuppressive Drugs in a Cohort of Kidney Transplant Patients

Pinchera Biagio  1 , Carrano Rosa  2 , Schiano Moriello Nicola  1 , Salemi Fabrizio  2 , Piccione Amerigo  2 , Zumbo Giulia  1 , Scotto Riccardo  1 , Villari Riccardo  1 , Romano Paolo  2 , Spirito Lorenzo  3 , Gentile Ivan  1 , Federico Ii Covid Team
Affiliations
Observational Study

Serological Response and Clinical Protection of Anti-SARS-CoV-2 Vaccination and the Role of Immunosuppressive Drugs in a Cohort of Kidney Transplant Patients

Pinchera Biagio et al. Viruses. .

Abstract

Vaccination against SARS-CoV2 represents a key weapon to prevent COVID-19, but lower response rates to vaccination have frequently been reported in solid organ transplant recipients. The aim of our study was to evaluate the rate of seroconversion to SARS-CoV-2 mRNA vaccines in a cohort of kidney transplant recipients and the potential role of the different immunosuppressive regimens. We conducted an observational retrospective cohort study in kidney transplant patients vaccinated for COVID-19. For each patient, we evaluated IgG anti-S-RBD SARS-CoV-2 titers immediately before the administration of first COVID-19 vaccination dose, 20 days after the first dose and 40 days after the second dose. Moreover, we evaluated the type of immunosuppressive treatment and the incidence of vaccine breakthrough SARS-CoV-2 infection. We enrolled 121 kidney transplant patients vaccinated for COVID-19. At the time of administration of the first vaccine dose, all patients had a negative antibody titer; only 4.1% had positive antibody titers 20 days after the first dose. More than half patients 62 (51%) had protective antibody titers 40 days after the second dose. A total of 18 Solid Organ Transplant Recipients (SOTRs) (14.9%) got a SARS-CoV-2 breakthrough infection during the study period. With regard to immunosuppressive regimen, patients on mycophenolate-based regimen (48.7%) showed the lowest antibody response rates (27.5%) compared to other regimens. Our study confirms that kidney transplant patients show a poor response to two doses of COVID-19 vaccination. Moreover, in our study the use of mycophenolate is significantly associated with a non-response to COVID-19 m-RNA vaccines.

Keywords: COVID-19; SARS-CoV-2; immunosuppression; serological response; transplant; vaccination.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Kaplan-Meier curves: positive vs. negative serology in breakthrough infection (in days).
Figure 2
Figure 2
Kaplan-Meier curves: positive vs. negative serology in COVID-19 (in days).
Figure 3
Figure 3
Kaplan-Meier curves: positive vs. negative serology in Severe COVID-19 (in days).
See this image and copyright information in PMC

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