Immunity to SARS-CoV-2 in renal transplant and dialysis pati
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The SARS-CoV-2 continues to spread worldwide. Dialysis patients (DP) and kidney transplant recipients (KTR) are especially vulnerable to COVID-19, as these patients experience a high percentage of complicated cases and a much higher mortality rate as compared to the normal population.

A new study published in The Lancet Regional Health - Europe analyzes the humoral and cellular immune responses of more than 3,100 Saxonian participants comprised of medical personnel (MP), as well as immunocompromised DP and immunosuppressed KTR patients. The humoral and cellular response rates and qualities were analyzed 4-5 weeks after the participants received their second vaccine dose of either vaccine.

To assess a pure vaccine-induced immune response, scientists constructed a “pure vaccination” cohort and a “clinical vaccination” cohort. The start date (T0) was defined as immediately before the first vaccination. Comparably, T1 was defined as three (Pfizer/BioNTech) to four (Moderna) weeks after the first dose, whereas T2 was defined as eight weeks after the start of the study or five to four weeks after the booster vaccine dose.

For all participants, SARS-CoV-2 specific immunoglobulin G (IgG)- or IgA-antibody reactions against the S1 and S2 subunits of the spike protein and the IgG- antibodies against the nucleocapsid protein subunit (NCP), at T0 and T2. Additionally, the receptor-binding domain (RBD) antibody formation was also examined at T2.

Results:

- The pure vaccination cohort had 1,768 participants (144 MP, 1256 DP, and 368 KTR), all of whom were monitored at and up to eight weeks after vaccination. In the MP group, the seroconversion rate was 96% in T1 and 99% in T2. All participants in the MP group developed SARS-CoV-2 RBD antibodies at T2. Using the IGRA, scientists documented the cellular vaccination rate to be 81% at T1 and 86% at T2.

- In the DP cohort, the seroconversion rate was also high at 95% at T2, with RBD antibodies detected in 95% of seroconversion positive DP cases at T2. Using IGRA, the cellular immune response rate was found to be 44% at T1 and 78% at T2. The researchers also observed a marked increase in the vaccine-reactive CD4+ T-cell response in the DP group at T2 as compared to pre-vaccination at T0 and T1.

- Finally, for the KTR cohort, the seroconversion rate was quite low at about 8% at T1 and 42% at T2. As compared to the previous groups, the RBD antibody response rate in the KTR group was also low at 65%.

- Post-vaccination, KTR patients showed a significant delay in T-cell responses, similar to DP patients. However, a marked increase was observed after the booster vaccine dose.

Conclusion:

A thorough understanding of the vaccine-induced modifications in SARS-CoV-2 specific immunity can help scientists devise effective vaccination strategies to contain the ongoing pandemic. Taken together, the results of the current study indicate that vaccination is safe but additional modifications to vaccination protocols, including booster doses for vulnerable individuals, should be considered.

Source:
https://www.sciencedirect.com/science/article/pii/S2666776221001551?via=ihub
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