EC Pulmonology and Respiratory Medicine

A recent study revealed that SARS-CoV-2 (COVID-19) infection caused acute kidney injury and mortality around 50% and 23% of the infected cases, respectively [1]. With different mRNA COVID-19 vaccination in immunocompromised patients, such as kidney transplant recipients (KTRs), solid organ transplant recipients (SOTRs), etc. binding and neutralizing antibodies measurement clearly revealed lower levels, compared to healthy persons [2-6]. A number of previous studies demonstrated that KTRs or non-KTRs with renal failure markedly reduced vaccine response, whereas adaptive protocols of mRNA COVID-19 vaccination or alternative adjuvant vaccines is now not known yet [7,8]. Whereas protective immunity is further impaired immunosuppressants, thus fully restoring adaptive, cellular immunity and renal function in KTRs cannot occur and increase susceptibility to viral-related malignancies and infections [9-11]. After two doses of mRNA-COVID-19 vaccines, the seroconversion rates in KTRs were relatively low that varied from 4% to 57% [12,13] and decreased with increasing age [13,14]. A recent study demonstrated that everolimus (EVR), a mammalian target of rapamycin (mTOR) inhibitor had a higher seroconversion after mRNA-COVID-19 vaccination among KTRs, in comparison to mycophenolate mofetil (MMF) therapy (Figure 1 and 2) [15].

1. Hovd M., et al. “Humoral vaccine response and breakthrough infections in kidney transplant recipients during the COVID-19 pandemic: a nationwide cohort study”. Lancet (2023): 102035.
2. Rincvon-Arevalo H., et al. “Impaired humoral immunity to SARS-CoV-2 BNT162b2 vaccine in kidney transplant recipients and dialysis patients”. Science Immunology 60 (2021): eabj1031.
3. Stumpf J., et al. “Humoral and cellular immunity to SARS-CoV-2 vaccination in renal transplant versus dialysis patients: a prospective, multicenter observational study using mRNA 1273 or BNT162b2 mRNA vaccine”. The Lancet Regional Health Europe 9 (2021): 100178.
4. Chen JJ., et al. “Immunogenicity rates after SARS-CoV-2 vaccination in people with end-stage kidney disease: a systematic review and meta-analysis”. The Journal of the American Medical Association Network Open 10 (2021): e2131749.
5. Strengert M., et al. “Cellular and humoral immunogenicity of a SARS-CoV-2 mRNA vaccine in patients on hemodialysis”. EBio Medicine 70 (2021): 103524.
6. Stumpf JKA., et al. “Equivalent humoral and cellular immune response but different side effect rates following SARS-CoV-2 vaccination in peritoneal and hemodialysis patients using messenger RNA”. Nephrology Dialysis Transplantation 4 (2022): 796-798.
7. Mulley WR., et al. “Primary seroresponses to double-dose compared with standard-dose hepatitis B vaccination in patients with chronic kidney disease: a systematic review and meta-analysis”. Nephrology Dialysis Transplantation 32 (2017): 136-143.
8. Liao Z., et al. “Effect of a booster dose of influenza vaccine in patients with hemodialysis, peritoneal dialysis and renal transplant recipients: a systematic literature review and meta-analysis”. Human Vaccines and Immunotherapeutics 12 (2016): 2909-2915.
9. Syed-Ahmed M and Narayanan M. “Immune dysfunction and risk of infection in chronic kidney disease”. Advances in Chronic Kidney Disease 26 (2019): 8-15.
10. Kato S., et al. “Aspects of immune dysfunction in end-stage renal disease”. Clinical Journal of the American Society of Nephrology 3 (2008): 1526-1533.
11. Betjes MGH. “Immune cell dysfunction and inflammation in end-stage renal disease”. Nature Reviews Nephrology 9 (2013): 255-265.
12. Caillard S and Thaunat O. “COVID-19 vaccination in kidney transplant recipients”. Nature Reviews Nephrology 17 (2021): 785-787.
13. Sanders JF., et al. “RECOVAC Collaborators. The RECOVAC immune-response study : the immunogenicity, tolerability, and safety of COVID-19 vaccination in patients with chronic kidney disease, on dialysis, or living with a kidney transplant”. Transplantation 106 (2022): 821-834.
14. Rozen-Zvi B., et al. “Antibody response to SARS CoV-2 mRNA vaccine among kidney transplant recipients: a prospective cohort study”. Clinical Microbiology and Infection 27 (2021): 1173.e1-1173.e4.
15. De Boer SE., et al. “Enhanced humoral immune response after COVID-19 vaccination in elderly kidney transplant recipients on everolimus versus mycophenolate mofetil-containing immunosuppressive regimens”. Transplantation 8 (2022): 1615-1621.