Cellular immune response of SARS-CoV-2 vaccination in kidney transplant recipients: a systematic review and meta-analysis

Suwasin Udomkarnjananun; Sivaporn Gatechompol; Asada Leelahavanichkul; Stephen J Kerr

doi:10.3389/fimmu.2023.1220148

Cellular immune response of SARS-CoV-2 vaccination in kidney transplant recipients: a systematic review and meta-analysis

Front Immunol. 2023 Jul 26:14:1220148. doi: 10.3389/fimmu.2023.1220148. eCollection 2023.

Authors

Suwasin Udomkarnjananun^{1

2

3}, Sivaporn Gatechompol⁴, Asada Leelahavanichkul^{5

6}, Stephen J Kerr^{4

7

8}

Affiliations

¹ Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
² Excellence Center for Organ Transplantation (ECOT), King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
³ Renal Immunology and Transplantation Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
⁴ HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
⁵ Center of Excellence on Translational Research in Inflammation and Immunology (CETRII), Department of Microbiology, Chulalongkorn University, Bangkok, Thailand.
⁶ Immunology Unit, Department of Microbiology, Chulalongkorn University, Bangkok, Thailand.
⁷ Biostatistics Excellence Centre, Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
⁸ The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.

Abstract

Background: Evidence has demonstrated inferior humoral immune responses after SARS-CoV-2 vaccination in kidney transplant recipients compared to the general population. However, data on cellular immune responses in this population have not been established.

Methods: We searched the MEDLINE, Scopus, and Cochrane databases and included studies reporting cellular immune response rates in kidney transplant recipients after receiving SARS-CoV-2 vaccines. Studies that reported factors associated with cellular immune responders or non-responders were also included (PROSPERO: CRD42022375544).

Results: From a total of 1,494 articles searched, 53 articles were included in the meta-analysis. In all, 21 studies assessed cellular immune response by interferon-γ enzyme-linked immunosorbent spot (IFN-γ ELISPOT), 22 studies used interferon-γ release assay (IGRA), and 10 studies used flow cytometric analysis. The pooled response rate after two doses (standard regimen) and three doses of vaccination was 47.5% (95%CI 38.4-56.7%) and 69.1% (95%CI 56.3-80.6%) from IFN-γ ELISPOT, 25.8% (95%CI 19.7-32.4%) and 14.7% (95%CI 8.5-22.2%) from IGRA, and 73.7% (95%CI 55.2-88.8%) and 86.5% (95%CI 75.3-94.9%) from flow cytometry, respectively. Recipients with seroconversion were associated with a higher chance of having cellular immune response (OR 2.58; 95%CI 1.89-3.54). Cellular immune response in kidney transplant recipients was lower than in dialysis patients (OR 0.24; 95%CI 0.16-0.34) and the general population (OR 0.10; 95%CI 0.07-0.14). Age and immunosuppressants containing tacrolimus or corticosteroid were associated with inferior cellular immune response.

Conclusion: Cellular immune response after SARS-CoV-2 vaccination in kidney transplant recipients was lower than in dialysis patients and the general population. Age, tacrolimus, and corticosteroid were associated with poor response. Cellular immune response should also be prioritized in vaccination studies.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022375544.

Keywords: COVID-19; Elispot; SARS-CoV-2 vaccine; T cells; cellular immune response; flow cytometry; interferon-γ; kidney transplantation.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

COVID-19 / prevention & control
COVID-19 Vaccines* / immunology
Humans
Kidney Transplantation*

Substances

COVID-19 Vaccines

Grants and funding

This study is supported by the Ratchadapisek Sompoch Endowment Fund of Chulalongkorn University (CU_GR_63_157_30_60).