Abstract
Background: Belatacept may impair humoral immunity, impacting the effectiveness of SARS-CoV-2 mRNA vaccines in transplant recipients. We investigated immunogenicity after SARS-CoV-2 mRNA vaccines in kidney transplant recipients who are and are not taking belatacept.
Methods: Participants were recruited between December 9, 2020, and April 1, 2021. Blood samples were collected after dose 1 and dose 2 (D1, D2) and analyzed using either an anti-SARS-CoV-2 enzyme immunoassay against the S1 domain of the SARS-CoV-2 spike protein or immunoassay against the receptor-binding domain of the SARS-CoV-2 spike protein. Stabilized inverse probability of treatment weights was used to compare immunogenicity, and a weighted logistics regression was used to calculate fold change of positive response.
Results: Among the 609 participants studied, 24 (4%) were taking belatacept. After dose 1, 0/24 (0%) belatacept patients had detectable antibodies, compared with 77 of 568 (14%) among the equivalent nonbelatacept population (P = 0.06). After dose 2, 1/19 (5%) belatacept patients had detectable antibodies, compared with 190/381 (50%) among the equivalent nonbelatacept population (P < 0.001). Belatacept use was associated with 16.7-fold lower odds of having a positive post-D2 titer result (P < 0.01).
Conclusions: Additional measures need to be explored to protect kidney transplant recipients taking belatacept. Best safety practices should be continued despite vaccination among this population.
【초록키워드】 Treatment, antibodies, SARS-CoV-2, vaccination, immunogenicity, mRNA vaccine, anti-SARS-CoV-2, Spike protein, Probability, immunoassay, Humoral immunity, Receptor-binding domain, SARS-CoV-2 spike protein, Patient, Effectiveness, enzyme immunoassay, kidney transplant recipient, belatacept, kidney transplant recipients, dose, Fold change, recipients, Blood samples, enzyme, blood sample, measure, participant, positive response, positive, S1 domain, PROTECT, analyzed, was used, collected, recruited, investigated, detectable, the receptor-binding domain, impair, calculate, the SARS-CoV-2, 【제목키워드】 SARS-CoV-2, Transplant, mRNA, recipient, Taking,