Infectious Disease

COVID-19 vaccine shows varying degrees of effectiveness in patients with kidney failure

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Bertrand does not disclose any relevant financial information. Please refer to the study for all relevant financial information from the other authors.

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Renal failure patients who received Pfizer-BioNTech’s COVID-19 vaccine showed variable levels of antibody and T-cell responses, with dialysis patients achieving greater protection from the vaccine than transplant recipients.

The study, conducted in France and published in the Journal of the American Society of Nephrology, included 45 kidney transplant recipients and 10 patients undergoing chronic hemodialysis.

COVID-19 vaccine for patients with kidney failure

The content of the infographic was adapted from Bertrand D, et al. J Am Soc Nephrol. 2021; doi: 10.1681 / ASN.2021040480.

“The vaccine appears to be effective in dialysis patients, suggesting that vaccination should be highly recommended in these patients.” Dominique Bertrand, MD, the department of nephrology, transplantation and hemodialysis of the University Hospital Rouen, it says in a related press release. “In contrast, the low level of antibody response seen in kidney transplant recipients is worrying; However, antibodies are not the full spectrum of protection induced by the vaccine. T-cell immunity is probably also very important. ”

Specific results showed that 88.9% of dialysis patients developed anti-spike SARS-CoV-2 antibodies after two doses of vaccine and 100% showed a specific T cell response against the virus.

The vaccine appeared to be less effective for transplant recipients as the researchers observed a “barely induced” antibody response after the first dose of vaccine. After the second dose, 17.8% developed an antibody response and 51.1% developed an anti-spike T-cell specific response.

“Our results suggest that the immune response to the BNT262b2 vaccine is largely influenced by the intensity of the immunosuppressive regime,” the researchers write. “Patients treated with belatacept actually reacted the worst, developed no antibodies and no or only a few specific T cells. There is even a suspicion that belatacept has an increased incidence of opportunistic infections and [cytomegalovirus] CMV disease. Patients treated with tacrolimus also responded poorly to vaccination, although significant T cell counts were induced in some of them. It should be noted that the majority of our patients up [mycophenolate mofetil] MMF, which may have contributed to interfering with post-vaccination antibody responses. “

Regarding next steps, Bertrand and colleagues argued that it will be important to evaluate post-vaccination data on the incidence of COVID-19 in order to prioritize the prevention of infections in patients with kidney failure. Priorities could include immunizing “household members and close contacts” of transplant recipients, researchers suggested.

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