Comparison of antibody response to SARS-CoV-2 after two doses of inactivated virus and BNT162b2 mRNA vaccines in kidney transplant

Mariana Seija; Florencia Rammauro; José Santiago; Natalia Orihuela; Catherine Zulberti; Danilo Machado; Cecilia Recalde; Javier Noboa; Victoria Frantchez; Rossana Astesiano; Federico Yandián; Ana Guerisoli; Álvaro Morra; Daniela Cassinelli; Cecilia Coelho; Belén de Aramburu; Paulina González-Severgnini; Romina Moreno; Aldana Pippolo; Gabriela López; Mónica Lemos; Lorena Somariva; Eliana López; Soledad Fumero; Carla Orihuela; Rosalía Rodríguez; Gonzalo Acuña; Victoria Rabaza; Nancy Perg; Rossana Cordero; Cristina Reisfeld; Paula Olivera; Paola Montero; Cecilia Nogueira; Catheryn Nalerio; Sergio Orihuela; Lilián Curi; Ema Burgstaller; Oscar Noboa; Otto Pritsch; Marcelo Nin; Sergio Bianchi

doi:10.1093/ckj/sfab291

Comparison of antibody response to SARS-CoV-2 after two doses of inactivated virus and BNT162b2 mRNA vaccines in kidney transplant

Clin Kidney J. 2021 Dec 27;15(3):527-533. doi: 10.1093/ckj/sfab291. eCollection 2022 Mar.

Authors

Mariana Seija¹, Florencia Rammauro², José Santiago¹, Natalia Orihuela³, Catherine Zulberti³, Danilo Machado⁴, Cecilia Recalde⁴, Javier Noboa¹, Victoria Frantchez⁵, Rossana Astesiano¹, Federico Yandián¹, Ana Guerisoli¹, Álvaro Morra³, Daniela Cassinelli⁶, Cecilia Coelho⁶, Belén de Aramburu⁶, Paulina González-Severgnini⁶, Romina Moreno⁶, Aldana Pippolo⁶, Gabriela López⁷, Mónica Lemos⁷, Lorena Somariva⁷, Eliana López⁷, Soledad Fumero⁷, Carla Orihuela⁷, Rosalía Rodríguez⁴, Gonzalo Acuña⁴, Victoria Rabaza⁴, Nancy Perg⁴, Rossana Cordero⁴, Cristina Reisfeld⁴, Paula Olivera⁴, Paola Montero⁴, Cecilia Nogueira⁴, Catheryn Nalerio³, Sergio Orihuela³, Lilián Curi³, Ema Burgstaller⁴, Oscar Noboa¹, Otto Pritsch², Marcelo Nin¹, Sergio Bianchi⁸

Affiliations

¹ Centro de Nefrología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
² Laboratorio de Inmunovirología, Institut Pasteur de Montevideo, Montevideo, Uruguay.
³ Centro de Trasplante INU, Hospital Italiano, Montevideo, Uruguay.
⁴ Centro de Trasplante, Hospital Evangélico, Montevideo, Uruguay.
⁵ Cátedra de Enfermedades Infecciosas, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
⁶ Students of Scientific Methods 2, Medical Doctor Degree, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
⁷ Departamento de Enfermería, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
⁸ Departamento de Fisiopatología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.

Abstract

Background: Antibody response against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) after mRNA or adenoviral vector-based vaccines is weak in kidney transplant (KT) patients. However, few studies have focused on humoral response after inactivated virus-based vaccines in KT. Here, we compare antibody response following vaccination with inactivated virus (CoronaVac®) and BNT162b2 mRNA.

Methods: A national multicentre cross-sectional study was conducted. The study group was composed of patients from all KT centres in Uruguay, vaccinated between 1 and 31 May 2021 (CoronaVac®, n = 245 and BNT162b2, n = 39). The control group was constituted of 82 healthy individuals. Participants had no prior confirmed coronavirus disease 2019 (COVID-19) test. Blood samples were collected between 30 and 40 days after the second dose. Serum-specific immunoglobulin G (IgG) antibodies against the receptor-binding domain (RBD) of SARS-CoV-2 Spike protein were determined using the COVID-19 IgG QUANT ELISA Kit.

Results: Only 29% of KT recipients showed seroconversion (36.5% BNT162b2, 27.8% inactivated virus, P = 0.248) in comparison with 100% in healthy control with either vaccine. Antibody levels against RBD were higher with BNT162b mRNA than with inactivated virus [median (interquartile range) 173 (73-554) and 29 (11-70) binding antibody units (BAU)/mL, P < 0.034] in KT and 10 times lower than healthy control [inactivated virus: 308 (209-335) and BNT162b2: 2638 (2608-3808) BAU/mL, P < 0.034]. In multivariate analysis, variables associated with negative humoral response were age, triple immunosuppression, estimated glomerular filtration rate and time post-KT.

Conclusion: Seroconversion was low in KT patients after vaccination with both platforms. Antibody levels against SARS-CoV-2 were lower with inactivated virus than BNT162b mRNA. These findings support the need for strategies to improve immunogenicity in KT recipients after two doses of either vaccine.

Keywords: COVID-19; SARS-CoV-2 vaccine; kidney transplantation.