Impact of tozinameran (BNT162b2) mRNA vaccine on kidney transplant and chronic dialysis patients: 3–5 months follow-up

• Published in: Journal of nephrology Vol. 35; no. 1; pp. 153 - 164
• Main Authors: Ben-Dov, Iddo Z., Oster, Yonatan, Tzukert, Keren, Alster, Talia, Bader, Raneem, Israeli, Ruth, Asayag, Haya, Aharon, Michal, Burstein, Ido, Pri-Chen, Hadas, Imam, Ashraf, Abel, Roy, Mor-Yosef Levi, Irit, Khalaileh, Abed, Oiknine-Djian, Esther, Bloch, Aharon, Wolf, Dana G., Dranitzki Elhalel, Michal
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 2022
• Subjects: Aged; BNT162 Vaccine; Cohort Studies; COVID-19; Female; Follow-Up Studies; Humans; Kidney Transplantation; Male; Medicine; Medicine & Public Health; mRNA Vaccines; Nephrology; Original; Original Article; Prospective Studies; Renal Dialysis; RNA, Messenger; SARS-CoV-2; Urology; Vaccines, Synthetic; COVID-19; End-stage renal disease; Hemodialysis; Vaccines; Viral infections; Peritoneal dialysis; Kidney transplantation
• ISSN: 1121-8428; 1724-6059
• DOI: 10.1007/s40620-021-01210-y

Background Determining the humoral immunogenicity of tozinameran (BNT162b2) in patients requiring chronic renal replacement therapy, and its impact on COVID-19 morbidity several months after vaccination, may guide risk assessment and changes in vaccination policy. Methods In a prospective post-vaccination cohort study with up to 5 months follow-up we studied outpatient dialysis and kidney transplant patients and respective healthcare teams. Outcomes were anti S1/S2 antibody responses to vaccine or infection, and infection rate during follow-up. Results One hundred seventy-five dialysis patients (40% women, 65 ± 15 years), 252 kidney transplant patients (33% women, 54 ± 14 years) and 71 controls (65% women, 44 ± 14 years) were followed. Three months or longer after vaccination we detected anti S1/S2 IgG antibodies in 79% of dialysis patients, 42% of transplant recipients and 100% of controls, whereas respective rates after infection were 94%, 69% and 100%. Predictors of non-response were older age, diabetes, history of cancer, lower lymphocyte count and lower vitamin-D levels. Factors associated with lower antibody levels in dialysis patients were modality (hemodialysis vs peritoneal) and high serum ferritin levels. In transplant patients, hypertension and higher calcineurin or mTOR inhibitor drug levels were linked with lower antibody response. Vaccination was associated with fewer subsequent infections (HR 0.23, p < 0.05). Moreover, higher antibody levels (particularly above 59 AU/ml) were associated with fewer events, with a HR 0.41 for each unit increased in log 10 titer (p < 0.05). Conclusions Dialysis patients, and more strikingly kidney transplant recipients, mounted reduced antibody response to COVID-19 mRNA vaccination. Lesser humoral response was associated with more infections. Measures to identify and protect non-responsive patients are required. Graphic abstract