Antibody acquisition after second and third SARS-CoV-2 vaccinations in Japanese kidney transplant patients: a prospective study

Hidetaka Deguchi; Atsuhiko Sakamoto; Nobuyuki Nakamura; Yasuhiro Okabe; Yoshifumi Miura; Takeshi Iida; Michinobu Yoshimura; Nobuhiro Haga; Shigeki Nabeshima; Kosuke Masutani

doi:10.1007/s10157-023-02334-0

Antibody acquisition after second and third SARS-CoV-2 vaccinations in Japanese kidney transplant patients: a prospective study

Clin Exp Nephrol. 2023 Jun;27(6):574-582. doi: 10.1007/s10157-023-02334-0. Epub 2023 Mar 13.

Authors

Affiliations

¹ Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Japan.
² Department of General Medicine, Fukuoka University Hospital, Fukuoka, Japan.
³ Department of Urology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
⁴ Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
⁵ Department of General Surgery, Hara-Sanshin Hospital, Fukuoka, Japan.
⁶ Meotoiwa Hospital, Fukuoka, Japan.
⁷ Department of Microbiology and Immunology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
⁸ Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Japan. kmasutani@fukuoka-u.ac.jp.

^# Contributed equally.

Abstract

Background: Kidney transplant patients have lower antibody acquisition after SARS-CoV-2 vaccination. The efficacy of vaccines in Japanese kidney transplant patients with specific characteristics, such as predominant living-donor, ABO-incompatible kidney transplant, and low-dose immunosuppression, requires verification.

Methods: We conducted a prospective study to estimate anti-SARS-CoV-2 antibody levels in 105 kidney transplant patients and 57 controls. Blood samples were obtained before vaccination, 1, 3, and 6 months after second vaccination, and 1 month after third vaccination. We investigated antibody acquisition rates, antibody levels, and factors associated with antibody acquisition.

Results: One month after second vaccination, antibody acquisition was 100% in the controls but only 36.7% in the kidney transplant group (P < 0.001). Antibody levels in positive kidney transplant patients were also lower than in the controls (median, 4.9 arbitrary units vs 106.4 arbitrary units, respectively, P < 0.001). Years after kidney transplant (odds ratio 1.107, 95% confidence interval 1.012-1.211), ABO-incompatible kidney transplant (odds ratio 0.316, 95% confidence interval 0.101-0.991) and mycophenolate mofetil use (odds ratio 0.177, 95% confidence interval 0.054-0.570) were significant predictors for antibody acquisition after second vaccination. After third vaccination, antibody positivity in the kidney transplant group increased to 75.3%, and antibody levels in positive patients were 71.7 arbitrary units. No factors were associated with de novo antibody acquisition.

Conclusions: In Japanese kidney transplant patients, years after kidney transplant, ABO-incompatible kidney transplant and mycophenolate mofetil use were predictors for antibody acquisition after second vaccination. Third vaccination improves antibody status even in patients who were seronegative after the second vaccination.

Keywords: BNT162b2; COVID-19; Immunosuppressive agents; Messenger RNA; mRNA-1273.

MeSH terms

Antibodies, Viral
COVID-19 Vaccines* / immunology
COVID-19* / prevention & control
East Asian People
Humans
Kidney Transplantation*
Mycophenolic Acid / therapeutic use
Prospective Studies
SARS-CoV-2
Transplant Recipients
Vaccination

Substances

Antibodies, Viral
COVID-19 Vaccines
Mycophenolic Acid