Humoral and Cellular Responses to mRNA-1273 and BNT162b2 SARS-CoV-2 Vaccines Administered to Hemodialysis Patients

• Published in: American journal of kidney diseases Vol. 78; no. 4; pp. 571 - 581
• Main Authors: Broseta, José Jesús, Rodríguez-Espinosa, Diana, Rodríguez, Néstor, Mosquera, María del Mar, Marcos, María Ángeles, Egri, Natalia, Pascal, Mariona, Soruco, Erica, Bedini, José Luis, Bayés, Beatriu, Maduell, Francisco
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2021; by the National Kidney Foundation, Inc
• Subjects: 2019-nCoV Vaccine mRNA-1273; Adult; Aged; Aged, 80 and over; Antibody response; BNT162 Vaccine; cellular response; Cohort Studies; COVID-19; COVID-19 - epidemiology; COVID-19 - immunology; COVID-19 - prevention & control; COVID-19 vaccines; COVID-19 Vaccines - administration & dosage; end-stage renal disease (ESRD); Female; hemodialysis; Humans; humoral response; Immunity, Cellular - immunology; Immunity, Humoral - immunology; immunogenicity; immunosuppression; Male; Middle Aged; mRNA vaccines; Original Investigation; Prospective Studies; Renal Dialysis; SARS-CoV-2; seroconversion; T-Lymphocytes - immunology; COVID-19; COVID-19 vaccines; SARS-CoV-2; cellular response; seroconversion; end-stage renal disease (ESRD); hemodialysis; mRNA vaccines; immunosuppression; immunogenicity; Antibody response; humoral response
• ISSN: 0272-6386; 1523-6838
• DOI: 10.1053/j.ajkd.2021.06.002

Patients with kidney failure who are receiving maintenance dialysis have a higher risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and worse clinical outcomes after coronavirus disease 2019 (COVID-19) than the general population. Therefore, immunization against SARS-CoV-2 with effective vaccines is an important component of health-maintenance strategies for these patients. This study evaluated the humoral and cellular responses to messenger RNA (mRNA) SARS-CoV-2 vaccines in this population. Observational prospective multicenter cohort study. 205 patients treated at 3 dialysis units at the Hospital Clínic of Barcelona (Spain) were vaccinated from February 3 to April 4, 2021, and followed until April 23, 2021. Immunization with either the mRNA-1273 (Moderna) or BNT162b2 (Pfizer-BioNTech) SARS-CoV-2 mRNA vaccine. Seroconversion, defined as the detection of IgG antibodies to the receptor-binding domain of the S1 spike antigen of SARS-CoV-2 (anti–S1-RBD IgG), and the identification of activated CD4+T cells 3 weeks after completing vaccination. Anti-S1-RBD IgG levels were also analyzed as a secondary outcome. Univariate and multivariable logistic and multiple linear regression models were used to evaluate the associations between vaccination and study outcomes. We found that 97.7% of 175 vaccinated patients who were seronegative at baseline developed a response (humoral, cellular, or both); 95.4% of these patients seroconverted, while 62% of those tested for cellular immunity had a positive response. Greater age and immunosuppressive treatment were associated with lower antibody levels. Mandatory vaccine administration by health authorities. Anti–S1-RBD IgG levels were reported up to 150U/mL and cellular immune responses were characterized qualitatively. Antibody assay and cellular response assessment may not be comparable with previously published laboratory approaches. Immunization with mRNA vaccines generated a humoral and cellular immune response in a high proportion of patients with kidney failure receiving maintenance dialysis. These findings as well as the high risk of infection and poor clinical outcomes among these patients make their vaccination a health priority.