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. 2022 Nov 26;14(12):2646.
doi: 10.3390/v14122646.

Immune Response to Third and Fourth COVID-19 Vaccination in Hemodialysis Patients and Kidney Transplant Recipients

Patrick Affeldt  1   2 , Felix Carlo Koehler  1   3 , Karl August Brensing  4 , Martin Gies  5 , Eva Platen  6 , Vivien Adam  1 , Linus Butt  1   3 , Franziska Grundmann  1 , Eva Heger  2 , Steffen Hinrichs  1 , Nils Kalisch  1 , Simon Oehm  1 , Gertrud Steger  2 , Maike Wirtz  2 , Thomas Benzing  1   3 , Dirk Stippel  7 , Florian Klein  2 , Christine Kurschat  1   3 , Roman-Ulrich Müller  1   3 , Veronica Di Cristanziano  2
Affiliations

Immune Response to Third and Fourth COVID-19 Vaccination in Hemodialysis Patients and Kidney Transplant Recipients

Patrick Affeldt et al. Viruses. .

Abstract

Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is a serious hazard for hemodialysis (HD) patients and kidney transplant (KTX) recipients as they suffer from an impaired immune response to SARS-CoV-2 vaccination. In addition, a definition of SARS-CoV-2 IgG titer that indicates a sufficient immune response, especially against new omicron variants, is urgently needed. In the present study, the immune response to either a third or a fourth dose of a mRNA vaccine was investigated in 309 dialysis and 36 KTX patients. SARS-CoV-2 IgG titer thresholds indicating neutralizing activity against wild type (WT) and the omicron variant BA.1 were quantified. After four vaccine doses, a high-neutralizing activity against WT was evidenced in HD patients, whereas the neutralizing rate against BA.1 was significant lower. Concerning KTX recipients, humoral and cellular immune responses after a third vaccination were still highly impaired. This calls for modified omicron-targeting vaccines.

Keywords: BA.1; SARS-CoV-2; booster; dialysis; immunosuppression; kidney disease; neutralization; protection; surrogate; transplantation.

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Conflict of interest statement

The authors declare no conflict of interests.

Figures

Figure 1
Figure 1
SARS-CoV-2 anti-receptor binding domain (RBD) IgG responses after third (blue) and fourth (purple) vaccination. Median days after the second dose are given on the x-axis and anti-RBD IgG titers on the y-axis. Doted black lines indicate median SARS-CoV-2 IgG titers and solid black lines correspond to the interquartile range (IQR).
Figure 2
Figure 2
Anti-receptor binding domain (RBD) IgG response after three and four doses of an mRNA vaccine in hemodialysis (HD) patients. Doted red lines indicate median SARS-CoV-2 IgG titers and solid red lines correspond to the interquartile range (IQR). Doted orange lines represent examined cut-offs for neutralizing activity against WT and BA.1.
Figure 3
Figure 3
Comparison between commercial serological assays targeting different regions of the SARS-CoV-2 spike protein. Doted red lines indicate median SARS-CoV-2 IgG titers and solid red lines correspond to the interquartile range (IQR).
Figure 4
Figure 4
Correlation between SARS-CoV-2 IgG titers and the serum neutralizing activity against wild type (WT) and the omicron variant BA.1. Solid red line: median titer.
See this image and copyright information in PMC

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