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
Baker, Stephen
Lear, Sara
Hosmilo, Myra
Pritchard, Nicholas
Torpey, Nicholas
Jayne, David
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
Research, Vaccine, SARS-CoV-2, Immunosuppression, Rituximab, Mycophenolate, Transplant, Dialysis, Autoimmune, Antibody
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/
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