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SARS-COV-2 vaccine responses in renal patient populations.

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cam.issuedOnline2022-05-31
dc.contributor.authorSmith, Rona M
dc.contributor.authorCooper, Daniel J
dc.contributor.authorDoffinger, Rainer
dc.contributor.authorStacey, Hannah
dc.contributor.authorAl-Mohammad, Abdulrahman
dc.contributor.authorGoodfellow, Ian
dc.contributor.authorBaker, Stephen
dc.contributor.authorLear, Sara
dc.contributor.authorHosmilo, Myra
dc.contributor.authorPritchard, Nicholas
dc.contributor.authorTorpey, Nicholas
dc.contributor.authorJayne, David
dc.contributor.authorYiu, Vivien
dc.contributor.authorChalisey, Anil
dc.contributor.authorLee, Jacinta
dc.contributor.authorVilnar, Enric
dc.contributor.authorCheung, Chee Kay
dc.contributor.authorJones, Rachel B
dc.contributor.orcidCooper, Daniel [0000-0002-3643-7605]
dc.contributor.orcidBaker, Stephen [0000-0003-1308-5755]
dc.contributor.orcidJayne, David [0000-0002-1712-0637]
dc.date.accessioned2022-06-07T08:11:47Z
dc.date.available2022-06-07T08:11:47Z
dc.date.issued2022-05-31
dc.date.submitted2021-12-24
dc.date.updated2022-06-07T08:11:46Z
dc.description.abstractBACKGROUND: 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.
dc.identifier.doi10.17863/CAM.85172
dc.identifier.eissn1471-2369
dc.identifier.issn1471-2369
dc.identifier.others12882-022-02792-w
dc.identifier.other2792
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/337763
dc.languageen
dc.language.isoeng
dc.publisherSpringer Science and Business Media LLC
dc.publisher.urlhttp://dx.doi.org/10.1186/s12882-022-02792-w
dc.subjectAntibody
dc.subjectAutoimmune
dc.subjectDialysis
dc.subjectImmunosuppression
dc.subjectMycophenolate
dc.subjectRituximab
dc.subjectSARS-CoV-2
dc.subjectTransplant
dc.subjectVaccine
dc.subjectAutoimmune Diseases
dc.subjectBNT162 Vaccine
dc.subjectCOVID-19
dc.subjectCOVID-19 Vaccines
dc.subjectHumans
dc.subjectMycophenolic Acid
dc.subjectRenal Dialysis
dc.subjectRituximab
dc.subjectSARS-CoV-2
dc.subjectViral Vaccines
dc.titleSARS-COV-2 vaccine responses in renal patient populations.
dc.typeArticle
dcterms.dateAccepted2022-04-11
prism.issueIdentifier1
prism.publicationNameBMC Nephrol
prism.volume23
pubs.funder-project-idWellcome Trust (207498/Z/17/Z)
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by/4.0/
rioxxterms.versionVoR
rioxxterms.versionofrecord10.1186/s12882-022-02792-w

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