Abstract
Background: Assessing the composition of immune responses to SARS-CoV-2 vaccines is critical for our understanding of protective immunity, especially for immune compromised patients. The Pfizer (BNT162b2) vaccination showed >90% efficacy in protecting individuals from infection. However, these studies did not examine responses in immunocompromised kidney transplant patients (KT). Subsequent reports in KT have shown severe deficiencies in Spike-specific immunoglobin G (IgG) responses prompting booster vaccinations, but a broader understanding of T-cell immunity to vaccinating is lacking.
Methods: We examined SARS-CoV-2 Spike IgG and CD4+/CD8+ Spike-specific T-cell responses in 61 KT patients maintained on different immunosuppressive protocols (ISP) (Tac + mycophenolate mofetil + prednisone) versus (belatacept + MMF + prednisone) and compared to 41 healthy controls. We also examined cytomegalovirus-cytotoxic T-cell responses (CMV-Tc) in both groups to assess T-cell memory.
Results: Our data confirmed poor Spike IgG responses in vaccinated KT patients with both ISP (21% demonstrating Spike IgG 1M post-second dose of BNT162b2 vs. 93% in controls). However, 35% of Spike IgG (-) patients demonstrated CD4+ and/or CD8+ T-cell responses. All but one CMV-IgG+ patient demonstrated good CMV-Tc responses. No differences in T-cell immunity by ISP were seen.
Conclusion: Immunocompromised KT recipients showed severe defects in humoral and T-cell immune response after vaccination. No differences in immune responses to SARS-CoV-2 Spike peptides were observed in KT patients by ISP post-vaccination. The detection of Spike-specific T-cell immunity in the absence of Spike IgG suggests that vaccination in immunocompromised KT patients may provide partial immunity, although not preventing infection, T-cell immunity may limit its severity.
Keywords: SARS-CoV-2; belatacept; kidney transplant; tacrolimus; vaccine.
【저자키워드】 SARS-CoV-2, vaccine., kidney transplant, belatacept, tacrolimus, 【초록키워드】 IgG, Efficacy, Vaccine, immune response, vaccination, protocol, spike, severity, T-cell Response, Infection, peptide, SARS-CoV-2 vaccines, immune, SARS-CoV-2 vaccine, memory, kidney, BNT162b2, Pfizer, protective immunity, immune responses, response, Patient, peptides, Immunocompromised, cytomegalovirus, Prednisone, T-cell, Critical, patients, kidney transplant, T-cell responses, spike IgG, T-cell immunity, belatacept, tacrolimus, dose, immunosuppressive, humoral, mycophenolate, IgG responses, IgG response, mycophenolate mofetil, partial immunity, both groups, deficiencies, individual, no differences, CD4+, healthy controls, recipient, booster vaccinations, responses, controls, limit, severe deficiency, shown, examined, absence, demonstrated, Assessing, CD8+ T-cell, in both group, ISP, MMF, of BNT162b2, preventing infection, 【제목키워드】 SARS CoV-2, vaccination, Cellular immune response, Immunocompromised, assessment, Allograft, humoral, renal, recipient,