Transplantation Direct (Nov 2022)

Humoral and Cellular Immune Responses After a 3-dose Course of mRNA-1273 COVID-19 Vaccine in Kidney Transplant Recipients: A Prospective Cohort Study

  • David Cucchiari, MD, PhD,
  • Natalia Egri, MD,
  • Diana Rodriguez-Espinosa, MD,
  • Enrique Montagud-Marrahi, MD,
  • Joaquim Casals-Urquiza, MD,
  • Jimena Del Risco-Zevallos, MD,
  • Marta Bodro, MD, PhD,
  • Pedro Ventura-Aguiar, MD, PhD,
  • Frederic Cofan, MD, PhD,
  • Judit Cacho, MD,
  • Alicia Molina-Andujar, MD,
  • Jordi Rovira, PhD,
  • Elisenda Banon-Maneus, PhD,
  • Maria José Ramirez-Bajo, PhD,
  • Anna Pérez-Olmos, RN,
  • Marta Garcia-Pascual, RN, PhD,
  • Mariona Pascal, MD, PhD,
  • Anna Vilella, MD, PhD,
  • Antoni Trilla, MD, PhD,
  • Eduard Palou, MD, PhD,
  • Ignacio Revuelta, MD, PhD,
  • Manel Juan, MD, PhD,
  • Josep M. Campistol, MD, PhD,
  • Frederic Oppenheimer, MD, PhD,
  • Asunción Moreno, MD, PhD,
  • Josep M. Miró, MD, PhD,
  • Beatriu Bayés, MD, PhD,
  • Fritz Diekmann, MD, PhD

DOI
https://doi.org/10.1097/TXD.0000000000001389
Journal volume & issue
Vol. 8, no. 11
p. e1389

Abstract

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Background. In kidney transplant recipients, there is discordance between the development of cellular and humoral response after vaccination against SARS-CoV-2. We sought to determine the interplay between the 2 arms of adaptive immunity in a 3-dose course of mRNA-1273 100 μg vaccine. Methods. Humoral (IgG/IgM) and cellular (N- and S-ELISpot) responses were studied in 117 kidney and 12 kidney-pancreas transplant recipients at the following time points: before the first dose, 14 d after the second dose‚ and before and after the third dose, with a median of 203 and 232 d after the start of the vaccination cycle, respectively. Results. After the second dose, 26.7% of naive cases experienced seroconversion. Before the third dose and in the absence of COVID-19, this percentage increased to 61.9%. After the third dose, seroconversion occurred in 80.0% of patients. Naive patients who had at any time point a detectable positivity for S-ELISpot were 75.2% of the population, whereas patients who maintained S-ELISpot positivity throughout the study were 34.3%. S-ELISpot positivity at 42 d was associated with final seroconversion (odds ratio‚ 3.14; 95% confidence interval‚ 1.10-8.96; P = 0.032). Final IgG titer was significantly higher in patients with constant S-ELISpot positivity (P < 0.001). Conclusions. A substantial proportion of kidney transplant recipients developed late seroconversion after 2 doses. Cellular immunity was associated with the development of a stronger humoral response.