ABSTRACT
Background: While anti-SARS-CoV-2 vaccination success in kidney transplant recipients (KTR) after two doses and 1273-mRNA was associated with higher seroconversion rates compared to BNT162b2-mRNA in our "DIA-Vacc Study" (NCT04799808), it remains unclear whether this may also be the case in non-responding KTR after a third vaccination dose. Materials and Methods: Non-responding KTR (after two mRNA vaccinations) were investigated 4.5-6 months after study enrollment at first vaccination. One hundred sixty-six of 193 received a third vaccination between 3.5 and 5 months after the initial study enrollment and were always investigated 4 weeks later, exploring humoral immune response (ELISA) and specific cellular responses (interferon-γ release assay). Sixty-seven of 193 measurements in KTR were done immediately before the third vaccination or in KTR without further vaccination at 4.5-6 months. Results: Of 193 KTR with no initial immune response 4 weeks after the second vaccination, 106/87 were immunized twice with 1273-mRNA/BNT162b2-mRNA, respectively. Additional mRNA booster vaccination led to positive seroconversion rates of 30-50%, while 16% of the initial non-responders demonstrated a delayed seroconversion without any booster vaccination. Using logistic regression analysis, a positive IgG response after the third vaccination was 23% more likely if the primary vaccine type was 1273-mRNA compared to BNT162b2-mRNA (OR = 4.420, 95% CI [1.208-16.173], p = 0.025). Primary vaccine type, a weak anti-SpikeS1 IgG response 4 weeks after second vaccination (3.2-35.2 BAU/ml, p < 0.001) and a lack of MMF/MPA as part of the immunosuppressive treatment (trend, p = 0.06) but no other variables studied correlated with seroconversion success. Conclusion: This observational study adds important evidence toward using 1273-mRNA as the primary mRNA vaccine type for immunosuppressed KTR.
ABSTRACT
Introduction and importance: As immunocompromised individuals, kidney transplant recipients (KTR) were more prone to severe and prolonged COVID-19 infection. Case presentation: A 52-year-old man with a history of two kidney transplants for polycystic kidney disease (PKD) was hospitalized due to COVID-19 illness after receiving the first dose of COVID-19 vaccination with Sputnik V. After being admitted to the hospital, the patient was given Remdesivir and oxygen therapy. Clinical discussion: We reported a COVID-19 infection after the first dose of Sputnik V vaccination in an immunocompromised patient who did not follow the protocols after vaccination. Regardless of vaccination, he had been infected, but the vaccination saved him from severe infection despite his comorbidity. Conclusion: To summarise, infection with COVID-19 should be considered after vaccinations, particularly the first dose, in immunocompromised patients such as KTR, and protocols for these patients should be strictly followed. It is worth mentioning that even a full dose of vaccination does not provide full protection from infection to anyone, including KTR.