{"doi":"10.34067/kid.0003512021","title":"Impaired Immune Response to SARS-CoV-2 Vaccination in Dialysis Patients and in Kidney Transplant Recipients","abstract":"<jats:sec>\n            <jats:title>Key Points</jats:title>\n            <jats:p>\n                                 <jats:list list-type=\"bullet\"><jats:list-item><jats:p>Immune response to the coronavirus disease 2019 vaccination is significantly reduced in patients with kidney failure compared with controls without kidney failure.</jats:p></jats:list-item><jats:list-item><jats:p>After two vaccinations, kidney transplant recipients show the lowest levels of IgGs specific to severe acute respiratory syndrome coronavirus 2, with the lowest neutralizing capacity.</jats:p></jats:list-item><jats:list-item><jats:p>These data suggest that vaccination strategies need modification in kidney transplant recipients and patients on dialysis.</jats:p></jats:list-item></jats:list>\n                              </jats:p>\n          </jats:sec>\n          <jats:sec>\n            <jats:title>Background</jats:title>\n            <jats:p>Patients with kidney failure on dialysis or after renal transplantation have a high risk for severe COVID-19 infection, and vaccination against SARS-CoV-2 is the only expedient prophylaxis. Generally, immune responses are attenuated in patients with kidney failure, however, systematic analyses of immune responses to SARS-CoV-2 vaccination in patients on dialysis and in kidney transplant recipients (KTRs) are still needed.</jats:p>\n          </jats:sec>\n          <jats:sec>\n            <jats:title>Methods</jats:title>\n            <jats:p>In this prospective, multicentric cohort study, antibody responses to COVID-19 mRNA vaccines (BNT162b2 [BioNTech/Pfizer] or mRNA-1273 [Moderna]) were measured in 32 patients on dialysis and in 28 KTRs. SARS-CoV-2–specific antibodies and neutralization capacity were evaluated and compared with controls (<jats:italic toggle=\"yes\">n</jats:italic>=78) of a similar age range.</jats:p>\n          </jats:sec>\n          <jats:sec>\n            <jats:title>Results</jats:title>\n            <jats:p>After the first vaccination, SARS-CoV-2–specific antibodies were nearly undetectable in patients with kidney failure. After the second vaccination, 93% of the controls and 88% of patients on dialysis but only 37% of KTRs developed SARS-CoV-2–specific IgG above cutoff. Moreover, mean IgG levels were significantly lower in KTRs (54±93 BAU/ml) compared with patients on dialysis (503±481 BAU/ml; <jats:italic toggle=\"yes\">P</jats:italic>&lt;0.01). Both KTRs and patients on dialysis had significantly lower IgG levels compared with controls (1992±2485 BAU/ml; <jats:italic toggle=\"yes\">P</jats:italic>&lt;0.001 and <jats:italic toggle=\"yes\">P</jats:italic>&lt;0.01, respectively). Importantly, compared with controls, neutralizing antibody titers were significantly lower in KTRs and patients on dialysis. After the second vaccination, 76% of KTRs did not show any neutralization capacity against SARS-CoV-2, suggesting impaired seroprotection.</jats:p>\n          </jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions</jats:title>\n            <jats:p>Patients with kidney failure show a significantly weaker antibody response compared with controls. Most strikingly, only one out of four KTRs developed neutralizing antibodies against SARS-CoV-2 after two doses of vaccine. These data suggest that vaccination strategies need modification in KTRs and patients on dialysis.</jats:p>\n            <jats:p>\n                                 <jats:bold>Clinical Trial registry name and registration number:</jats:bold> Vaccination Against COVID-19 in Chronic Kidney Disease, NCT04743947</jats:p>\n          </jats:sec>","journal":"Kidney360","year":2021,"id":18587,"datarank":2.088106057694057,"base_score":3.912023005428146,"endowment":3.912023005428146,"self_citation_contribution":0.586803450814222,"citation_network_contribution":1.501302606879835,"self_endowment_contribution":0.586803450814222,"citer_contribution":1.501302606879835,"corpus_percentile":null,"corpus_rank":null,"citation_count":49,"citer_count":40,"citers_with_citation_signal":30,"citers_with_endowment":30,"datacite_reuse_total":2,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":128626,"name":"Svenja Fischer","orcid":null,"position":1,"is_corresponding":false},{"id":128627,"name":"Lisa Müller","orcid":null,"position":2,"is_corresponding":false},{"id":128628,"name":"Nadine Lübke","orcid":null,"position":3,"is_corresponding":false},{"id":128629,"name":"Jonas Hillebrandt","orcid":null,"position":4,"is_corresponding":false},{"id":128630,"name":"Marcel Andrée","orcid":null,"position":5,"is_corresponding":false},{"id":128631,"name":"Michael Schmitz","orcid":null,"position":6,"is_corresponding":false},{"id":128632,"name":"Claudia Schmidt","orcid":null,"position":7,"is_corresponding":false},{"id":128633,"name":"Seher Küçükköylü","orcid":null,"position":8,"is_corresponding":false},{"id":128634,"name":"Lynn Koster","orcid":null,"position":9,"is_corresponding":false},{"id":128635,"name":"Margarethe Kittel","orcid":null,"position":10,"is_corresponding":false},{"id":128636,"name":"Lea Weiland","orcid":null,"position":11,"is_corresponding":false},{"id":128637,"name":"Karl W. Dreyling","orcid":null,"position":12,"is_corresponding":false},{"id":128638,"name":"Gerd Hetzel","orcid":null,"position":13,"is_corresponding":false},{"id":128639,"name":"Ortwin Adams","orcid":null,"position":14,"is_corresponding":false},{"id":128640,"name":"Heiner Schaal","orcid":"0000-0002-1636-4365","position":15,"is_corresponding":false},{"id":128641,"name":"Katrin Ivens","orcid":null,"position":16,"is_corresponding":false},{"id":128642,"name":"Lars C. 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