Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccination may fail to sufficiently protect transplant recipients against coronavirus disease 2019 (COVID-19). We retrospectively evaluated COVID-19 in kidney transplant recipients (n = 226) after BNT162b2 mRNA vaccine administration. The control group consisted of unvaccinated patients (n = 194) during the previous pandemic wave. We measured anti-spike protein immunoglobulin G (IgG) levels and cellular responses, using enzyme-linked immunosorbent spot assay, in a prospective cohort after vaccination (n = 31) and recovery from COVID-19 (n = 19). COVID-19 was diagnosed in 37 (16%) vaccinated and 43 (22%) unvaccinated patients. COVID-19 severity was similar in both groups, with patients exhibiting a comparable need for hospitalization (41% vs. 40%, p = 1.000) and mortality (14% vs. 9%, p = .726). Short posttransplant periods were associated with COVID-19 after vaccination (p < .001). Only 5 (16%) patients achieved positive SARS-CoV-2 IgG after vaccination, and 17 (89%, p < .001) recovered from COVID-19 (median IgG levels, 0.6 vs. 52.5 AU/ml, p < .001). A cellular response following vaccination was present in the majority (n = 22, 71%), with an increase in interleukin 2 secreting T cells (p < .001). Despite detectable T cell immunity after mRNA vaccination, kidney transplant recipients remained at a high risk of severe COVID-19. Humoral responses induced by vaccination were significantly lower than that after COVID-19.

Biomedical Centre Faculty of Medicine in Pilsen Charles University Pilsen Czech Republic

Department of Immunochemistry Diagnostics Faculty of Medicine in Pilsen Charles University and Teaching Hospital Pilsen Czech Republic

Department of Immunology and Allergology Faculty of Medicine in Pilsen Charles University and Teaching Hospital Pilsen Czech Republic

Department of Internal Medicine 1 Faculty of Medicine in Pilsen Charles University and Teaching Hospital Pilsen Czech Republic

Division of Information Technologies and Statistics Faculty of Medicine in Pilsen Charles University Pilsen Czech Republic

Am J Transplant. 2022 Jul;22(7):1927-1928. doi: 10.1111/ajt.16961. PubMed

Zobrazit více v PubMed

C4 article Implications of COVID-19 in transplantation. Am J Transplant. 2021;21(5):1801–1815. PubMed PMC

Danziger-Isakov L, Blumberg EA, Manuel O, Sester M. Impact of COVID-19 in solid organ transplant recipients. Am J Transplant. 2021;21(3):925–937. PubMed PMC

Softeland JM, Friman G, von Zur-Muhlen B, et al. COVID-19 in solid organ transplant recipients: a national cohort study from Sweden. Am J Transplant. 2021;21(8):2762–2773. PubMed PMC

Villanego F, Mazuecos A, Perez-Flores IM, et al. Predictors of severe COVID-19 in kidney transplant recipients in the different epidemic waves: analysis of the Spanish Registry. Am J Transplant. 2021;21(7):2573–2582. PubMed PMC

Kates OS, Haydel BM, Florman SS, et al. COVID-19 in solid organ transplant: a multi-center cohort study. Clin Infect Dis. 2020:ciaa1097. doi: 10.1093/cid/ciaa1097. PubMed DOI

Chavarot N, Gueguen J, Bonnet G, et al. COVID-19 severity in kidney transplant recipients is similar to nontransplant patients with similar comorbidities. Am J Transplant. 2021;21(3):1285–1294. PubMed PMC

Sahin U, Muik A, Derhovanessian E, et al. COVID-19 vaccine BNT162b1 elicits human antibody and TH1 T cell responses. Nature. 2020;586(7830):594–599. PubMed

Polack FP, Thomas SJ, Kitchin N, et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med. 2020;383(27):2603–2615. PubMed PMC

Baden LR, El Sahly HM, Essink B, et al. Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. N Engl J Med. 2021;384(5):403–416. PubMed PMC

Lopez Bernal J, Andrews N, Gower C, et al. Effectiveness of covid-19 vaccines against the B.1.617.2 (delta) variant. N Engl J Med. 2021;385(7):585–594. PubMed PMC

Jalkanen P, Kolehmainen P, Hakkinen HK, et al. COVID-19 mRNA vaccine induced antibody responses against three SARS-CoV-2 variants. Nat Commun. 2021;12(1):3991. PubMed PMC

Glenn DA, Hegde A, Kotzen E, et al. Systematic review of safety and efficacy of COVID-19 vaccines in patients with kidney disease. Kidney Int Rep. 2021;6(5):1407–1410. PubMed PMC

Benotmane I, Gautier-Vargas G, Wendling MJ, et al. In-depth virological assessment of kidney transplant recipients with COVID-19. Am J Transplant. 2020;20(11):3162–3172. PubMed PMC

Thieme CJ, Anft M, Paniskaki K, et al. The magnitude and functionality of SARS-CoV-2 reactive cellular and humoral immunity in transplant population is similar to the general population despite immunosuppression. Transplantation. 2021;105(10):2156–2164. PubMed PMC

Fernandez-Ruiz M, Olea B, Gimenez E, et al. SARS-CoV-2-specific cell-mediated immunity in kidney transplant recipients recovered from COVID-19. Transplantation. 2021;105(6):1372–1380. PubMed

Fava A, Donadeu L, Sabe N, et al. SARS-CoV-2-specific serological and functional T cell immune responses during acute and early COVID-19 convalescence in solid organ transplant patients. Am J Transplant. 2021;21(8):2749–2761. PubMed PMC

Magicova M, Fialova M, Zahradka I, et al. Humoral response to SARS-CoV-2 is well preserved and symptom dependent in kidney transplant recipients. Am J Transplant. 2021;21(12):3926–3935. PubMed PMC

Rozen-Zvi B, Yahav D, Agur T, et al. Antibody response to SARS-CoV-2 mRNA vaccine among kidney transplant recipients: a prospective cohort study. Clin Microbiol Infect. 2021;27(8) 1173.e1-1173.e4. PubMed PMC

Rincon-Arevalo H, Choi M, Stefanski AL, et al. Impaired humoral immunity to SARS-CoV-2 BNT162b2 vaccine in kidney transplant recipients and dialysis patients. Sci Immunol. 2021;6(60):eabj1031. PubMed

Grupper A, Rabinowich L, Schwartz D, et al. Reduced humoral response to mRNA SARS-CoV-2 BNT162b2 vaccine in kidney transplant recipients without prior exposure to the virus. Am J Transplant. 2021;21(8):2719–2726. PubMed PMC

Boyarsky BJ, Werbel WA, Avery RK, et al. Antibody response to 2-dose SARS-CoV-2 mRNA vaccine series in solid organ transplant recipients. JAMA. 2021;325(21):2204. PubMed PMC

Sattler A, Schrezenmeier E, Weber UA, et al. Impaired humoral and cellular immunity after SARS-CoV-2 BNT162b2 (tozinameran) prime-boost vaccination in kidney transplant recipients. J Clin Invest. 2021;131(14):e150175. PubMed PMC

Cucchiari D, Egri N, Bodro M, et al. Cellular and humoral response after MRNA-1273 SARS-CoV-2 vaccine in kidney transplant recipients. Am J Transplant. 2021;21(8):2727–2739. PubMed PMC

Korber N, Behrends U, Hapfelmeier A, Protzer U, Bauer T. Validation of an IFNgamma/IL2 FluoroSpot assay for clinical trial monitoring. J Transl Med. 2016;14(1):175. PubMed PMC

Peng Y, Mentzer AJ, Liu G, et al. Broad and strong memory CD4(+) and CD8(+) T cells induced by SARS-CoV-2 in UK convalescent individuals following COVID-19. Nat Immunol. 2020;21(11):1336–1345. PubMed PMC

Cassaniti I, Percivalle E, Bergami F, et al. SARS-CoV-2 specific T-cell immunity in COVID-19 convalescent patients and unexposed controls measured by ex vivo ELISpot assay. Clin Microbiol Infect. 2021;27(7):1029–1034. PubMed PMC

Ong DSY, Fragkou PC, Schweitzer VA, Chemaly RF, Moschopoulos CD, Skevaki C. How to interpret and use COVID-19 serology and immunology tests. Clin Microbiol Infect. 2021;27(7):981–986. PubMed PMC

Wang P, Nair MS, Liu L, et al. Antibody resistance of SARS-CoV-2 variants B.1.351 and B.1.1.7. Nature. 2021;593(7857):130–135. PubMed

Corey L, Beyrer C, Cohen MS, Michael NL, Bedford T, Rolland M. SARS-CoV-2 variants in patients with immunosuppression. N Engl J Med. 2021;385(6):562–566. PubMed PMC

Caillard S, Chavarot N, Bertrand D, et al. Occurrence of severe COVID-19 in vaccinated transplant patients. Kidney Int. 2021;100(2):477–479. PubMed PMC

Tau N, Yahav D, Schneider S, Rozen-Zvi B, Abu Sneineh M, Rahamimov R. Severe consequences of COVID-19 infection among vaccinated kidney transplant recipients. Am J Transplant. 2021;21(8):2910–2912. PubMed PMC

Havlin J, Svorcova M, Dvorackova E, et al. Immunogenicity of BNT162b2 mRNA COVID-19 vaccine and SARS-CoV-2 infection in lung transplant recipients. J Heart Lung Transplant. 2021;40(8):754–758. PubMed PMC

Hirzel C, Chruscinski A, Ferreira VH, et al. Natural influenza infection produces a greater diversity of humoral responses than vaccination in immunosuppressed transplant recipients. Am J Transplant. 2021;21(8):2709–2718. PubMed

L’Huillier AG, Ferreira VH, Hirzel C, et al. T-cell responses following natural influenza infection or vaccination in solid organ transplant recipients. Sci Rep. 2020;10(1):10104. PubMed PMC

Gartner BC, Sester M. Diversity of antibody responses after influenza infection or vaccination-Needed or nice to have? Am J Transplant. 2021;21(8):2631–2632. PubMed PMC

Candon S, Thervet E, Lebon P, et al. Humoral and cellular immune responses after influenza vaccination in kidney transplant recipients. Am J Transplant. 2009;9(10):2346–2354. PubMed

Kumar D, Ferreira VH, Blumberg E, et al. A 5-year prospective multicenter evaluation of influenza infection in transplant recipients. Clin Infect Dis. 2018;67(9):1322–1329. PubMed

Planas D, Veyer D, Baidaliuk A, et al. Reduced sensitivity of SARS-CoV-2 variant delta to antibody neutralization. Nature. 2021;596(7871):276–280. PubMed

Natori Y, Shiotsuka M, Slomovic J, et al. A double-blind, randomized trial of high-dose vs standard-dose influenza vaccine in adult solid-organ transplant recipients. Clin Infect Dis. 2018;66(11):1698–1704. PubMed

Haddadin Z, Krueger K, Thomas LD, Overton ET, Ison M, Halasa N. Alternative strategies of posttransplant influenza vaccination in adult solid organ transplant recipients. Am J Transplant. 2021;21(3):938–949. PubMed

Kamar N, Abravanel F, Marion O, Couat C, Izopet J, Del Bello A. Three doses of an mRNA Covid-19 vaccine in solid-organ transplant recipients. N Engl J Med. 2021;385(7):661–662. PubMed PMC

Hall VG, Ferreira VH, Ku T, et al. Randomized trial of a third dose of mRNA-1273 vaccine in transplant recipients. N Engl J Med. 2021;385(13):1244–1246. PubMed PMC

Weinreich DM, Sivapalasingam S, Norton T, et al. REGN-COV2, a neutralizing antibody cocktail, in outpatients with Covid-19. N Engl J Med. 2021;384(3):238–251. PubMed PMC

A Randomized Trial of Valganciclovir Prophylaxis Versus Preemptive Therapy in Kidney Transplant Recipients