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Meta-Analysis
. 2023 Jul 26:14:1220148.
doi: 10.3389/fimmu.2023.1220148. eCollection 2023.

Cellular immune response of SARS-CoV-2 vaccination in kidney transplant recipients: a systematic review and meta-analysis

Suwasin Udomkarnjananun  1   2   3 , Sivaporn Gatechompol  4 , Asada Leelahavanichkul  5   6 , Stephen J Kerr  4   7   8
Affiliations
Meta-Analysis

Cellular immune response of SARS-CoV-2 vaccination in kidney transplant recipients: a systematic review and meta-analysis

Suwasin Udomkarnjananun et al. Front Immunol. .

Abstract

Background: Evidence has demonstrated inferior humoral immune responses after SARS-CoV-2 vaccination in kidney transplant recipients compared to the general population. However, data on cellular immune responses in this population have not been established.

Methods: We searched the MEDLINE, Scopus, and Cochrane databases and included studies reporting cellular immune response rates in kidney transplant recipients after receiving SARS-CoV-2 vaccines. Studies that reported factors associated with cellular immune responders or non-responders were also included (PROSPERO: CRD42022375544).

Results: From a total of 1,494 articles searched, 53 articles were included in the meta-analysis. In all, 21 studies assessed cellular immune response by interferon-γ enzyme-linked immunosorbent spot (IFN-γ ELISPOT), 22 studies used interferon-γ release assay (IGRA), and 10 studies used flow cytometric analysis. The pooled response rate after two doses (standard regimen) and three doses of vaccination was 47.5% (95%CI 38.4-56.7%) and 69.1% (95%CI 56.3-80.6%) from IFN-γ ELISPOT, 25.8% (95%CI 19.7-32.4%) and 14.7% (95%CI 8.5-22.2%) from IGRA, and 73.7% (95%CI 55.2-88.8%) and 86.5% (95%CI 75.3-94.9%) from flow cytometry, respectively. Recipients with seroconversion were associated with a higher chance of having cellular immune response (OR 2.58; 95%CI 1.89-3.54). Cellular immune response in kidney transplant recipients was lower than in dialysis patients (OR 0.24; 95%CI 0.16-0.34) and the general population (OR 0.10; 95%CI 0.07-0.14). Age and immunosuppressants containing tacrolimus or corticosteroid were associated with inferior cellular immune response.

Conclusion: Cellular immune response after SARS-CoV-2 vaccination in kidney transplant recipients was lower than in dialysis patients and the general population. Age, tacrolimus, and corticosteroid were associated with poor response. Cellular immune response should also be prioritized in vaccination studies.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022375544.

Keywords: COVID-19; Elispot; SARS-CoV-2 vaccine; T cells; cellular immune response; flow cytometry; interferon-γ; kidney transplantation.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of study selection.
Figure 2
Figure 2
Cellular immune response rate in kidney transplant recipients after receiving different numbers of SARS-CoV-2 vaccine doses. (A) IFN-γ ELSIPOT assay. (B) IGRA. (C) Flow cytometric analysis.
Figure 3
Figure 3
Cellular immune response rate in kidney transplant recipients by seroconversion status after at least two vaccine doses.
Figure 4
Figure 4
Cellular immune response rates in kidney transplant recipients compared to (A) dialysis patients and (B) healthy controls population.
Figure 5
Figure 5
Comparison of cellular and antibody immune responses between different populations. (A) Kidney transplant recipients who received two doses of vaccine (standard regimen). (B) Kidney transplant recipients who received three doses of vaccine (after booster dose). (C) Dialysis patients who received two doses of vaccine. (D) Control population who received two doses of vaccine. E+A+; both cellular and antibody response, E+A-; cellular response but no antibody response, E-A+; antibody response but no cellular response, E-A-; both negative cellular and antibody response.
See this image and copyright information in PMC

References

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