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COVID-19 Vaccine Updates
With input from Dr Monica Vasudev
1550: Weak antibody response following first dose of mRNA COVID-19 vaccine in kidney transplant recipients
- The burden of immunosuppression may induce a weak antibody response in kidney transplant recipients following first dose of an mRNA vaccine, noted a study published in Kidney International.
- International recommendations on COVID-19 vaccine distribution prioritize immunocompromised patients, including kidney transplant recipients. However, the guidance was issued without inclusion of this population in vaccine clinical trials.
- In the study, 242 kidney transplant recipients who had received the first dose of the Moderna vaccine from January 21 through January 28, 2021, were included. None of them had a history of COVID-19 diagnosis and tested negative for anti-SARS-CoV-2 antibodies on the day they were given the first dose of vaccine. Twenty eight days after the first dose, the antibody response against the spike protein was evaluated, with titres >50 arbitrary units per mL (AU/mL) considered as a positive serology.
- One kidney transplant recipient developed mild symptomatic COVID-19 seven days after the first dose and 26 (10.7%) kidney transplant recipients had a positive serology at 28 days after the dose.
- The median immunoglobulin (Ig)G titre was 224 AU/mL (interquartile range 76−496 AU/mL) in seropositive kidney transplant recipients, whereas the median IgG titre in the seronegative patients was < 6.8 AU/mL.
- Seroconverted patients had longer time from transplantation (median, 15.4 vs 5.8 years; P<0.001), had lesser odds of having received induction treatment (P< 0.001), were less likely to have received steroids (34.6% vs 61.9%, P = 0.01) and had lower level of serum creatinine (median, 104 vs 120 µmol/L;P = 0.05).
- This finding appears to be different from the immunocompetent individuals, who seroconverted after the first injection.
- The study emphasizes on the need to not delay the second vaccine dose in immunocompromised patients.
- Close surveillance must be considered to discuss the opportunity of a third dose in less responsive patients. (DG Alerts)
Dr KK Aggarwal
President CMAAO, HCFI and Past National President IMA