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B and T Cell Responses after a Third Dose of SARS-CoV-2 Vaccine in Kidney Transplant Recipients
Journal of the American Society of Nephrology  (IF10.121),  Pub Date : 2021-12-01, DOI: 10.1681/asn.2021070966
Eva Schrezenmeier, Hector Rincon-Arevalo, Ana-Luisa Stefanski, Alexander Potekhin, Henriette Staub-Hohenbleicher, Mira Choi, Friederike Bachmann, Vanessa Proβ, Charlotte Hammett, Hubert Schrezenmeier, Carolin Ludwig, Bernd Jahrsdörfer, Andreia C. Lino, Kai-Uwe Eckardt, Katja Kotsch, Thomas Dörner, Klemens Budde, Arne Sattler, Fabian Halleck

Background

Accumulating evidence sugges ts solid organ transplant recipients, as opposed to the general population, show strongly impaired responsiveness toward standard SARS-CoV-2 mRNA-based vaccination, demanding alternative strategies for protectio n o f this vulnerable group.

Methods

In line with recent recommendations, a third dose of either heterologous ChAdOx1 (AstraZeneca) or homologous BNT162b2 (BioNTech) was administered to 25 kidney transplant recipients (KTR) without humoral response after two doses of BNT162b2, followed by analysis of serological responses and vaccine-specific B- and T-cell immunity.

Results

Nine out of 25 (36%) KTR under standard immunosuppressive treatment seroconverted until day 27 after the third vaccination, whereas one patient developed severe COVID-19 infection immediately after vaccination. Cellular analysis 7 days after the third dose showed significantly elevated frequencies of viral spike-protein receptor-binding domain-specific B cells in humor al responders as compared with nonresponders. Likewise, portions of spike-reactive CD4+ T helper cells were significantly elevated in patients who were seroconverting. Furthermore, overall frequencies of IL-2+, IL-4+, and polyfunctional CD4+ T cells significantly increased after the third dose, whereas memory/effector differentiation remained unaffected.

Conclusions

Our data suggest a fraction of transplant recipients benefit from triple vaccination, where seroconversion is associated with quantitative and qualitative changes of cellular immunity. At the same time, the study highlights that modified vaccination approaches for immunosuppressed patients remain an urgent medical need.

Podcast

This article contains a podcast athttps://www.asn-online.org/media/podcast/JASN/2021_11_23_briggsgriffin112321.mp3