Antibody and T-cell responses 6 months after COVID-19 mRNA-1273 vaccination in patients with chronic kidney disease, on dialysis, or living with a kidney transplant

RECOVAC Collaborators , Jan Stephan F Sanders*, A Lianne Messchendorp, Rory D de Vries, Carla C Baan, Debbie van Baarle, Rob van Binnendijk, Dimitri A Diavatopoulos, Daryl Geers, Katharina S Schmitz, Corine H Geurts van Kessel, Gerco den Hartog, Marcia Ml Kho, Marion Pg Koopmans, Renate G van der Molen, Ester Bm Remmerswaal, Nynke Rots, Ron T Gansevoort, Frederike J Bemelman, Luuk B HilbrandsMarlies Ej Reinders

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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BACKGROUND: The immune response to COVID-19 vaccination is inferior in kidney transplant recipients (KTR), and to a lesser extent in patients on dialysis or with chronic kidney disease (CKD). We assessed the immune response 6 months after mRNA-1273 vaccination in kidney patients and compared this to controls.

METHODS: 152 participants with CKD stages G4/5 (eGFR <30  mL/min/1.73m2), 145 participants on dialysis, 267 KTR, and 181 controls were included. SARS-CoV-2 Spike S1-specific IgG antibodies were measured by fluorescent bead-based multiplex-immunoassay, neutralizing antibodies to ancestral, Delta and Omicron (BA.1) variants by plaque reduction, and T-cell responses by IFN-γ release assay.

RESULTS: At 6 months after vaccination S1-specific antibodies were detected in 100% of controls, 98.7% of CKD G4/5 patients, 95.1% of dialysis patients, and 56.6% of KTR. These figures were comparable to the response rates at 28 days, but antibody levels waned significantly. Neutralization of the ancestral and Delta variant was detected in most participants, whereas neutralization of Omicron was mostly absent. S-specific T-cell responses were detected 6 months in 75.0% of controls, 69.4% of CKD G4/5 patients, 52.6% of dialysis patients, and 12.9% of KTR. T-cell responses at 6 months were significantly lower than responses at 28 days.

CONCLUSIONS: Although seropositivity rates at 6 months were comparable to that at 28 days after vaccination, significantly decreased antibody levels and T-cell responses were observed. The combination of low antibody levels, reduced T-cell responses, and absent neutralization of the newly-emerging variants indicates the need for additional boosts or alternative vaccination strategies in KTR.

Original languageEnglish
Pages (from-to)e188-e199
Number of pages12
JournalClinical infectious diseases : an official publication of the Infectious Diseases Society of America
Issue number3
Early online date7-Jul-2022
Publication statusPublished - 1-Feb-2023

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