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Observational Study
. 2021 Nov 1;105(11):e226-e233.
doi: 10.1097/TP.0000000000003922.

Serological Response to the BNT162b2 COVID-19 mRNA Vaccine in Adolescent and Young Adult Kidney Transplant Recipients

Orly Haskin  1   2 , Liat Ashkenazi-Hoffnung  2   3 , Noa Ziv  2   4 , Yael Borovitz  1 , Amit Dagan  1   2 , Shelly Levi  1   2 , Gili Koren  1 , Gilad Hamdani  1 , Daniella Levi-Erez  1   2 , Daniel Landau  1   2 , Hadas Alfandary  1   2
Affiliations
Observational Study

Serological Response to the BNT162b2 COVID-19 mRNA Vaccine in Adolescent and Young Adult Kidney Transplant Recipients

Orly Haskin et al. Transplantation. .

Abstract

Background: Initial reports in adult kidney transplant recipients (KTR) indicate low immunogenicity after 2 doses of the BNT162b2 COVID-19 mRNA vaccine. We describe the immunogenicity of this vaccine compared to the serologic response in naturally infected COVID-19 positive adolescent and young adult KTR.

Methods: For this prospective observational study, the study group included 38 KTR who received 2 doses of the tested vaccine, and the control group included 14 KTR who had a previous polymerase chain reaction-confirmed COVID-19 infection.

Results: The mean age was 18 ± 3 y. Positive serologic responses were observed in 63% and 100% of the study and control groups, respectively (P = 0.01). Antibody titers were almost 30-fold higher in the control than the study group (median [interquartile range (IQR)]: 2782 [1908-11 000] versus 100.3 [4.7-1744] AU/mL, P < 0.001), despite the longer time from the COVID-19 infection to serologic testing compared to time from vaccination (median [IQR]: 157.5 [60-216] versus 37 [20.5-53] d, P = 0.011). Among vaccinated patients, higher proportions of those seronegative than seropositive were previously treated with rituximab (50% versus 8%, P = 0.01). Time from the second vaccine dose to serologic testing was longer in seropositive than seronegative patients (median [IQR]: 24.5 [15-40] versus 46 [27-56] d, P = 0.05). No patient developed symptomatic COVID-19 disease postvaccination.

Conclusions: The BNT162b2 COVID-19 mRNA vaccine yielded higher positive antibody response in adolescent and young adult KTR than previously reported for adult KTR. Antibody titers after vaccination were significantly lower than following COVID-19 infection. Longer time may be required to mount appropriate humoral immunity to vaccination in KTR.

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Conflict of interest statement

The authors declare no funding or conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
COVID-19 antibody titer levels in kidney transplant recipients. Levels are shown for patients who were vaccinated (gray dots) and who were infected with COVID-19 (black dots), according to the time from the second vaccine dose or from a positive polymerase chain reaction result. The solid line represents the positive cutoff value of 50 AU/mL. AU, antibody unit; COVID-19, coronavirus disease 2019.
FIGURE 2.
FIGURE 2.
Comparison of severe acute respiratory syndrome coronavirus 2 antibody titers in kidney transplant recipients, between those who were vaccinated and those who were post–COVID-19 infection. Antibody titer is shown in gray for vaccinated patients and black for post–COVID-19 patients. The solid line represents median titer level; X represents mean titer level; the boxes represent the interquartile range; whiskers represent the lowest and highest values within the range. Additional dots represent outliers that are 1.5 times above the third quartile. AU, antibody unit; COVID-19, coronavirus disease 2019.
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