Immune response after COVID-19 vaccination among patients with chronic kidney disease and kidney transplant

Abstract

Background: Vaccination of patients with chronic kidney disease (CKD) and kidney transplants (KTs) may achieve a less robust immune response. Understanding such immune responses is crucial for guiding current and future vaccine dosing strategies.

Methods: This prospective, observational study estimated the immunogenicity of humoral and cellular responses of two SARS-CoV-2 vaccines in different patient groups with CKD compared with controls. Secondary outcomes included adverse events after vaccination and the incidence of COVID-19 breakthrough infection, including illness severity.

Results: In total, 212 patients received ChAdOx1 nCoV-19 (89.62 %) or inactivated vaccines (10.38 %).The antibody response against the S protein was analyzed at T0 (before the first injection), T1 (before the second injection), and T2 (12 weeks after the second injection). Seroconversion occurred in 92.31 % of controls at T2 and in 100 % of patients with CKD, 42.86 % undergoing KT, 80.18 % of hemodialysis (HD), and 0 % of patients undergoing continuous ambulatory peritoneal dialysis (CAPD) at T2 of the ChAdOx1 nCoV-19 vaccine. Neutralizing antibody levels by surrogate virus neutralization test were above the protective level at T2 in each group. The KT group exhibited the lowest neutralizing antibody and T cell response. Blood groups O and vaccine type were associated with good immunological responses. After the first dose, 14 individuals (6.6 out of the total population experienced COVID-19 breakthrough infection.

Conclusion: Immunity among patients with CKD and HD after vaccination was strong and comparable with that of healthy controls. Our study suggested that a single dose of the vaccine is not efficacious and delays may result in breakthrough infection. Some blood groups and types of vaccine can affect the immune response.

Keywords: Anti-spike RBD IgG; Chronic kidney disease; Coronavirus disease 2019 (COVID-19); Kidney transplant; Vaccine.

Graphical abstract

Fig. 1

Study flowchart.

Fig. 2

Estimated glomerular filtration rate (eGFR) according to different patient groups.

Fig. 3

(A–B) Humoral immune responses against SARS-CoV-2 was assessed by Euroimmune ELISA for (A) antispike IgG antibodies and (B) neutralizing activities level in different groups of CKD patients compared to controls receiving ChAdOx1 nCoV-19 vaccine at T1 and T2 (C) Cellular immune response was assessed by interferon-gamma levels in different groups of patients compared to controls at T1 and T2. (D–F) Humoral and cellular responses to inactivated vaccines in different groups of CKD patients compared to controls at T1 and T2.

Fig. 4

(A–C) Seropositivity rates in vaccine serum samples elicited by ChAdOx1 nCoV-19. (D–F) Seropositivity rates in vaccine serum samples elicited by inactivated vaccines in different groups of patients at T1 and T2.

Fig. 5

(A) Correlation of anti-spike IgG levels with neutralizing antibodies. (B) Correlation of anti-spike IgG levels with interferon-gamma. (C) Correlation of neutralizing antibodies with interferon-gamma.