COVID-19 vaccine shows varying efficacy for patients with kidney failure
Patients with kidney failure who received the COVID-19 vaccine from Pfizer-BioNTech showed varying degrees of antibody and T-cell responses, with those on dialysis achieving greater protection from the vaccine than transplant recipients.
The study, which was conducted in France and published in the Journal of the American Society of Nephrology, included 45 kidney transplants recipients and 10 patients undergoing chronic hemodialysis.
“The vaccine seems efficient in individuals undergoing dialysis, indicating that vaccination should be highly recommended in these patients,” Dominique Bertrand, MD, of the department of nephrology, transplantation and hemodialysis at Rouen University Hospital, said in a related press release. “By contrast, the low antibody response observed 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 findings showed 88.9% of patients on dialysis developed anti-spike SARS-CoV-2 antibodies after receiving two vaccine doses and 100% exhibited a specific T-cell response against the virus.
The vaccine appeared less effective for transplant recipients, with researchers observing a “scarcely induced” antibody response after the first vaccine dose. 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 BNT262b2 vaccine is essentially influenced by the intensity of the immunosuppressive regimen,” the researchers wrote. “Belatacept-treated patients were indeed the worst responders, developing no antibodies and no or only few specific T cells. Belatacept is in fact suspected to be associated with an increased in the incidence of opportunistic infections and [cytomegalovirus] CMV disease. Tacrolimus-treated patients also responded weakly to vaccination, although significant T cell numbers were induced in some of them. It should be noted that the majority of our patients were on [mycophenolate mofetil] MMF, which may have contributed to impairing post-vaccine antibody responses.”
Regarding next steps, Bertrand and colleagues contended it will be important to evaluate post-vaccination data on the incidence of COVID-19 to determine priorities for preventing infection in patients with kidney failure. Priorities may include immunizing “household members and close contacts” of transplant recipients, researchers suggested.