SARS-COV-2 vaccine responses in renal patient populations.
Authors
Smith, Rona M
Cooper, Daniel J
Doffinger, Rainer
Stacey, Hannah
Al-Mohammad, Abdulrahman
Goodfellow, Ian
Lear, Sara
Hosmilo, Myra
Pritchard, Nicholas
Torpey, Nicholas
Yiu, Vivien
Chalisey, Anil
Lee, Jacinta
Vilnar, Enric
Cheung, Chee Kay
Jones, Rachel B
Publication Date
2022-05-31Journal Title
BMC Nephrol
ISSN
1471-2369
Publisher
Springer Science and Business Media LLC
Volume
23
Issue
1
Language
en
Type
Article
This Version
VoR
Metadata
Show full item recordCitation
Smith, R. M., Cooper, D. J., Doffinger, R., Stacey, H., Al-Mohammad, A., Goodfellow, I., Baker, S., et al. (2022). SARS-COV-2 vaccine responses in renal patient populations.. BMC Nephrol, 23 (1) https://doi.org/10.1186/s12882-022-02792-w
Abstract
BACKGROUND: Dialysis patients and immunosuppressed renal patients are at increased risk of COVID-19 and were excluded from vaccine trials. We conducted a prospective multicentre study to assess SARS-CoV-2 vaccine antibody responses in dialysis patients and renal transplant recipients, and patients receiving immunosuppression for autoimmune disease. METHODS: Patients were recruited from three UK centres (ethics:20/EM/0180) and compared to healthy controls (ethics:17/EE/0025). SARS-CoV-2 IgG antibodies to spike protein were measured using a multiplex Luminex assay, after first and second doses of Pfizer BioNTech BNT162b2(Pfizer) or Oxford-AstraZeneca ChAdOx1nCoV-19(AZ) vaccine. RESULTS: Six hundred ninety-two patients were included (260 dialysis, 209 transplant, 223 autoimmune disease (prior rituximab 128(57%)) and 144 healthy controls. 299(43%) patients received Pfizer vaccine and 379(55%) received AZ. Following two vaccine doses, positive responses occurred in 96% dialysis, 52% transplant, 70% autoimmune patients and 100% of healthy controls. In dialysis patients, higher antibody responses were observed with the Pfizer vaccination. Predictors of poor antibody response were triple immunosuppression (adjusted odds ratio [aOR]0.016;95%CI0.002-0.13;p < 0.001) and mycophenolate mofetil (MMF) (aOR0.2;95%CI 0.1-0.42;p < 0.001) in transplant patients; rituximab within 12 months in autoimmune patients (aOR0.29;95%CI 0.008-0.096;p < 0.001) and patients receiving immunosuppression with eGFR 15-29 ml/min (aOR0.031;95%CI 0.11-0.84;p = 0.021). Lower antibody responses were associated with a higher chance of a breakthrough infection. CONCLUSIONS: Amongst dialysis, kidney transplant and autoimmune populations SARS-CoV-2 vaccine antibody responses are reduced compared to healthy controls. A reduced response to vaccination was associated with rituximab, MMF, triple immunosuppression CKD stage 4. Vaccine responses increased after the second dose, suggesting low-responder groups should be prioritised for repeated vaccination. Greater antibody responses were observed with the mRNA Pfizer vaccine compared to adenovirus AZ vaccine in dialysis patients suggesting that Pfizer SARS-CoV-2 vaccine should be the preferred vaccine choice in this sub-group.
Keywords
Antibody, Autoimmune, Dialysis, Immunosuppression, Mycophenolate, Rituximab, SARS-CoV-2, Transplant, Vaccine, Autoimmune Diseases, BNT162 Vaccine, COVID-19, COVID-19 Vaccines, Humans, Mycophenolic Acid, Renal Dialysis, Rituximab, SARS-CoV-2, Viral Vaccines
Sponsorship
Wellcome Trust (207498/Z/17/Z)
Identifiers
s12882-022-02792-w, 2792
External DOI: https://doi.org/10.1186/s12882-022-02792-w
This record's URL: https://www.repository.cam.ac.uk/handle/1810/337763
Rights
Licence:
http://creativecommons.org/licenses/by/4.0/
Statistics
Total file downloads (since January 2020). For more information on metrics see the
IRUS guide.
Recommended or similar items
The current recommendation prototype on the Apollo Repository will be turned off on 03 February 2023. Although the pilot has been fruitful for both parties, the service provider IKVA is focusing on horizon scanning products and so the recommender service can no longer be supported. We recognise the importance of recommender services in supporting research discovery and are evaluating offerings from other service providers. If you would like to offer feedback on this decision please contact us on: support@repository.cam.ac.uk