Pre-Transplant Vaccine Induced SARS-CoV-2 Antibodies Decrease Following Induction Therapy for Kidney Transplantation

ABSTRACT

Purpose: Kidney transplant recipients (KT) and wait-listed individuals exhibit an impaired response to vaccinations. There is currently no data on the impact of induction immunosuppression followed by standard immunosuppression on the antibody (Ab) dynamics of wait-listed individuals undergoing KT. Here, we assess the SARS-CoV-2 antibody dynamics prior and one month following transplantation Methods: Previously immunized wait-listed patients (2 mRNA vaccine doses mRNA-1273 or BNT162b2 at least 14 days prior to KT) who subsequently underwent KT were included. Serum was collected within 24 hours prior to transplantation and 3-4 weeks following transplantation. ELISAs measuring anti-S and anti-RBD titers on pre- and post-transplant samples were performed. Serial dilutions of patient samples were prepared and AUC were calculated for paired samples from each participant. Paired samples were run simultaneously to reduce the effect of interplate variability. Wilcoxon and Mann-Whitney test were used to compare paired and unpaired samples, respectively Results: 35 patients were included (12 LKT/23 DDKT). 34 patients received induction with ATG, 1 with Basiliximab. Standard immunosuppression consisted of prednisone (2-week taper), mycophenolate and tacrolimus. 61% received mRNA- 1273 and 39% BNT162b2. We found no difference in Abs between vaccines. Anti- RBD Ab and anti-S Ab had a significant decline following KT at the one-month endpoint (anti-RBD Pre-KT 1581 vs Post-KT 473 p<0.0001 anti-S Ab Pre-KT 4058 vs 1739 p<0.0001). 29 wait-listed patients were on dialysis and had lower pre-transplant Abs (anti-RBD dialysis 1508 vs no dialysis 3790 p=0.5. Anti-S Ab dialysis 3841 vs no dialysis 10058 p=0.17). The differences remained post-KT. 3 patients developed COVID-19 following transplantation (median 123 days). They had lower pre- and post-transplant Ab (post-transplant anti-RBD COVID-19 181 vs no COVID-19 486 p=0.3, anti-S COVID-19 1672 vs no COVID-19 613 vs no COVID-19 1801 p=0.4) Conclusion(s) Induction immunosuppression followed by standard immunosuppression led to a significant decrease of both anti-S and anti-RBD ab in KT recipients. Waitlisted individuals on dialysis had lower Abs both pre-and post-transplant. Patients who developed post KT COVID-19 had lower Ab levels. Our data suggests that immediate post-transplant KTs may require additional vaccinations against COVID-19.