Abstract
Kidney transplant recipients (KTRs) are extremely vulnerable to SARS-CoV-2 infection and show an impaired immune response to SARS-CoV-2 vaccination. We analyzed factors related to vaccination efficiency in KTRs. In a multicenter prospective observational study ( NCT04743947 ), IgG antibodies levels against SARS-CoV-2 spike S1 subunit and their neutralization capacity after SARS-CoV-2 vaccination were analyzed in 225 KTRs and compared to 176 controls. After the vaccination, 56 (24.9%) KTRs became seropositive of whom 68% had neutralizing antibodies. This immune response was significantly lower compared to controls (239 [78-519] BAU/ml versus 1826 [560-3180] BAU/ml for KTRs and controls, p < .0001). The strongest predictor for an impaired response was mycophenolate mofetil (MMF) treatment. Multivariate regression analysis revealed that MMF-free regimen was highly associated with seroconversion (OR 13.25, 95% CI 3.22-54.6; p < .001). In contrast, other immunosuppressive drugs had no significant influence. 187 out of 225 KTRs were treated with MMF of whom 26 (13.9%) developed antibodies. 23 of these seropositive KTRs had a daily MMF dose ≤1 g. Furthermore, higher trough MMF concentrations correlated with lower antibody titers (R -0.354, p < .001) supporting a dose-dependent unfavorable effect of MMF. Our data indicate that MMF dose modification could lead to an improved immune response.
Keywords: clinical research/practice; immunosuppression/immune modulation; immunosuppressive regimens; infection and infectious agents – viral; kidney transplantation/nephrology; vaccine.
【저자키워드】 vaccine., clinical research/practice, infection and infectious agents - viral, immunosuppression/immune modulation, kidney transplantation/nephrology, immunosuppressive regimens, 【초록키워드】 Treatment, antibodies, Vaccine, immune response, vaccination, Neutralizing antibodies, prospective observational study, SARS-COV-2 infection, Infection, kidney, Seroconversion, IgG antibody, Antibody titer, Control, multicenter, multivariate regression analysis, seropositive, SARS-CoV-2 vaccination, SARS-CoV-2 spike, Concentration, S1 subunit, dose, neutralization capacity, immunosuppressive, Efficiency, regimen, infectious agent, Factor, 95% CI, Modification, recipient, significantly lower, controls, analyzed, treated, correlated, dose-dependent, had no, immunosuppressive drug, MMF, 【제목키워드】 Treatment, immune response, SARS-CoV-2 vaccination, kidney transplant recipient,