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Observational Study
. 2021 Nov 1;105(11):e234-e243.
doi: 10.1097/TP.0000000000003889.

Humoral Response of Renal Transplant Recipients to the BNT162b2 SARS-CoV-2 mRNA Vaccine Using Both RBD IgG and Neutralizing Antibodies

Tammy Hod  1   2   3 , Aharon Ben-David  1   2   3 , Liraz Olmer  4 , Itzchak Levy  3   5 , Ronen Ghinea  1   3 , Eytan Mor  1   3 , Yaniv Lustig  3   6 , Galia Rahav  3   5
Affiliations
Observational Study

Humoral Response of Renal Transplant Recipients to the BNT162b2 SARS-CoV-2 mRNA Vaccine Using Both RBD IgG and Neutralizing Antibodies

Tammy Hod et al. Transplantation. .

Abstract

Background: Data about SARS-CoV-2 vaccines efficacy in renal transplant recipients (RTR) are lacking.

Methods: To reveal predictors for humoral response to BNT162b2 vaccine among RTR, patients were divided into positive (N = 42) and negative (N = 78) response groups based on receptor-binding domain (RBD) immunoglobulin G (IgG) ≥1.1 and neutralizing antibodies (NA) ≥16 dilution versus RBD IgG <1.1 or NA <16, respectively. NA were detected using a SARS-CoV-2 pseudo-virus.

Results: NA were detected in only 42 of 120 (35%) of RTR versus 197 of 202 (97.5%) immunocompetent controls (P < 0.001). NA geometric mean titers in RTR were significantly lower versus the control group {83.7 (95% confidence interval [CI], 50.5-138.8) versus 482 (95% CI, 411-566), P < 0.001}. In a multivariable analysis, mycophenolic acid (MPA) dose and hemoglobin level were found to be independent predictors for antibody response in RTR. A positive response rate of 27% versus 63% was observed in patients on and off MPA, respectively. An increase in MPA dose by 1 mg/kg weight reduced the odds for a positive response by 17% (odds ratio = 0.83; 95% CI, 0.75-0.92; P < 0.001). Geometric mean titers for RBD IgG were significantly reduced as MPA daily dose increased. Hemoglobin blood level <13 g/dL reduced the antibody response by 63% (P = 0.04). Pain at the injection site after the second vaccine dose was significantly higher in the responders versus nonresponders (20.5% versus 5.5%, P = 0.01).

Conclusions: Only 35% of RTR develop NA to the BNT162b2 mRNA vaccine. MPA is a major suppressor of antibody response in RTR.

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Conflict of interest statement

The authors declare no funding or conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Correlation between RBD IgG and neutralizing antibodies in renal transplant recipients with a positive RBD IgG (N = 52). Each dot represents a combined IgG-RBD and neutralizing antibodies result for 1 participant. IgG, immunoglobulin G; RBD, receptor-binding domain; s/co, signal-to-cutoff ratio.
FIGURE 2.
FIGURE 2.
Effects of MPA daily dose on antibody response. A, Proportion of patients with positive antibody response following administration of the BNT162b2 vaccine stratified by total daily MPA dose. B, Geometrical mean of RBD IgG antibody levels stratified by total daily MPA dose. IgG, immunoglobulin G; MPA, mycophenolic acid; RBD, receptor-binding domain; s/co, signal-to-cutoff ratio.
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