Some kidney transplant patients develop COVID-19 antibodies after third vaccine dose
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In a study of kidney transplant patients who showed no immune response to two SARS-CoV-2 vaccines, 39% developed antibodies within 4 weeks of a third dose.
Further, there was no significant difference in response rates to the mRNA vaccine vs. the viral vector vaccine.
“Initial reports of a third dose of a SARS-CoV-2 vaccine in non- or low-responders showed promising results, with more than [one in three] patients developing antibodies against SARS-CoV-2,” Roman Reindl-Schwaighofer, MD, PhD, from the division of nephrology and dialysis in the department of internal medicine III at the Medical University of Vienna, in Vienna, Austria, and colleagues wrote. “We hypothesized that in [kidney transplant recipients] KTRs who did not develop antibodies against SARS-CoV-2 after [two] doses of mRNA vaccines, a heterologous vaccination strategy with a viral vector would improve the humoral response against SARS-CoV-2 compared with a third dose of the same mRNA vaccine.”
In a single center, single-blinded, 1:1 randomized clinical trial, researchers evaluated the effectiveness of a third dose of vaccine against SARS-CoV-2 in 197 adult kidney transplant recipients (mean age was 61.2 years; 58% were men). No patients developed SARS-CoV-2 spike protein antibodies after the first two doses of an mRNA vaccine. The trial took place between June 15 and Aug. 16, 2021. Analyses were performed between Aug. 17 and Aug. 31, 2021.
Within 28 days of being screened, participants received a single dose of either an mRNA vaccine or a vector-based vaccine. Follow-ups occurred on days 29 to 42 following the vaccination to determine the immune response level and possible adverse events in participants using the Elecsys Anti-SARS-CoV-2 enzyme immunoassay.
The primary outcome of this study was the amount of seroconversion in the mRNA and vector vaccination groups after 4 weeks after the third vaccine dose.
A total of 76 patients developed antibodies against the SARS-CoV-2 spike protein 4 weeks after the third vaccination. The response rate for the mRNA vaccine was 35% and the rate for the vector vaccine was 42%, showing there was no “statistically significant difference” between the homologous and heterologous vaccination methods.
“The findings of this randomized clinical trial show that homologous and heterologous vaccination strategies for a third SARS-CoV-2 vaccine dose in kidney transplant recipients are comparable, with both mRNA and vector vaccines achieving seroconversion in more than one-third of kidney transplant recipients,” Reindl-Schwaighofer and colleagues wrote. “However, given the high rate of non-responders after the third dose, additional strategies to induce an immune response in kidney transplant recipients are urgently needed.”
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