Comparison of humoral response in kidney transplant recipients and donors and healthy volunteers following second dose of SARS-CoV-2 mRNA vaccine

Purpose : To investigate the kinetics and durability of anti-spike glycoprotein (S) immunoglobulin G (IgG) following the 2nd dose of mRNA-based severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine in kidney transplant recipients (Recipients) compared with those in kidney donors (Donors) and healthy volunteers (HVs) and identify factors negatively associated with SARS-CoV-2 vaccine effectiveness in Recipients. Basic procedures We enrolled 378 Recipients who had no history of coronavirus disease 2019 (COVID-19) and no anti-S-IgG before the first vaccine and received a 2nd mRNA-based vaccine dose. Antibodies were detected using an immunoassay more than 4 weeks after the 2nd vaccine dose. Anti-S-IgG <0.8, ≥0.8–15, and ≥15 U/mL were considered negative, weak positive, and strong positive, respectively, whereas anti-N-IgG was negative. Anti-S-IgG titer was determined in 990 HVs and 102 Donors. Main findings Anti-S-IgG titers were 154, 2475, and 1181 U/mL in Recipient, HV, and Donor groups, respectively, with values significantly lower in Recipients. The anti-S-IgG-positivity rate of Recipients gradually increased following the 2nd vaccination, suggesting that Recipients had a delayed response compared with the HV and Donor groups having a 100% positivity rate at an earlier time point. Anti-S-IgG titers decreased in Donors and HVs, whereas it remained stable in Recipients, although at a significantly lower level. Independent negative factors associated with anti-S-IgG titers in Recipients were age >60 years and lymphocytopenia (OR: 2.35 and 2.44, respectively). Principal conclusions Kidney transplant recipients demonstrate delayed and attenuated responses with lower SARS-CoV-2 antibody titers after the 2nd dose of the mRNA-based COVID-19 vaccine.

Comparison of Humoral Response in Kidney Transplant Recipients and Donors and Healthy Volunteers Following Second Dose of SARS-CoV-2 mRNA Vaccine.

PURPOSE: To investigate the kinetics and durability of anti-spike glycoprotein (S) immunoglobulin G (IgG) after the second dose of mRNA-based SARS-CoV-2 vaccine in kidney transplant recipients (recipients) compared with those in kidney donors (donors) and healthy volunteers (HVs) and identify factors negatively associated with SARS-CoV-2 vaccine effectiveness in recipients. METHODS: We enrolled 378 recipients with no history of COVID-19 and no anti-S-IgG before the first vaccine and who received a second mRNA-based vaccine dose. Antibodies were detected using an immunoassay more than 4 weeks after the second vaccine dose. Anti-S-IgG <0.8, ≥0.8 to 15, and ≥15 U/mL were considered negative, weak positive, and strongly positive, respectively, whereas anti-nucleocapsid protein IgG was negative. Anti-S-IgG titer was determined in 990 HVs and 102 donors. RESULTS: Anti-S-IgG titers were 154, 2475, and 1181 U/mL in the recipient, HV, and donor groups, respectively, with values significantly lower in recipients. The anti-S-IgG-positivity rate of recipients gradually increased following the second vaccination, suggesting that recipients had a delayed response compared with the HV and donor groups, who had a 100% positivity rate at an earlier time point. Anti-S-IgG titers decreased in donors and HVs, whereas they remained stable in recipients, although at a significantly lower level. Independent negative factors associated with anti-S-IgG titers in recipients were age >60 years and lymphocytopenia (odds ratio: 2.35 and 2.44, respectively). CONCLUSIONS: Kidney transplant recipients demonstrate delayed and attenuated responses, with lower SARS-CoV-2 antibody titers after the second dose of the mRNA-based COVID-19 vaccine.

Successful immunomodulation in kidney transplant recipients with cytokine release syndrome after coronavirus disease.

Introduction: Patients with coronavirus disease, especially solid organ transplant recipients, are more susceptible to developing cytokine release syndrome than those with other viral infections. However, currently, treatment methods for such patients have not been established. Here, we describe two cases of successful immunomodulation in Japanese kidney transplant recipients with cytokine release syndrome following coronavirus disease. Case presentation: Two patients who had been receiving long-term immunosuppressant therapy developed coronavirus disease-associated pneumonia caused by cytokine release syndrome, following immunosuppressant dosage reduction. However, they recovered immediately after administration of tocilizumab with or without dexamethasone. Conclusion: The immunosuppressant dosage should be reduced to restore host immunity; however, immunomodulation should be considered in cases of suspected cytokine release syndrome.