Weak antibody response to three doses of mRNA vaccine in kidney transplant recipients treated with belatacept. Issue 12 (12th September 2021)

• Record Type: Journal Article
• Authors: Chavarot, Nathalie; Morel, Antoine; Leruez‐Ville, Marianne; Vilain, Estelle; Divard, Gillian; Burger, Carole; Serris, Alexandra; Sberro‐Soussan, Rebecca; Martinez, Frank; Amrouche, Lucile; Bererhi, Lynda; Lanternier, Fanny; Legendre, Christophe; Zuber, Julien; Anglicheau, Dany; Scemla, Anne
• Is Part Of: American journal of transplantation. Volume 21:Issue 12(2021)
• Page Start: 4043
• Page End: 4051
• Publication Date: 2021-09-12
• Subjects: belatacept -- COVID‐19 mRNA vaccine -- kidney transplant recipients -- three doses; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.16814
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract: Poor responses to mRNA COVID‐19 vaccine have been reported after 2 vaccine injections in kidney transplant recipients (KTRs) treated with belatacept. We analyzed the humoral response in belatacept‐treated KTRs without a history of SARS‐CoV‐2 infection who received three injections of BNT162b2‐mRNA COVID‐19 vaccine. We also investigated vaccine immunogenicity in belatacept‐treated KTRs with prior COVID‐19 and characterized symptomatic COVID‐19 infections after the vaccine in belatacept‐treated KTRs. Among the 62 belatacept‐treated KTRs (36 [58%] males), the median age (63.5 years IQR [51–72]), without COVID‐19 history, only four patients (6.4%) developed anti‐SARS‐CoV‐2 IgG with low antibody titers (median 209, IQR [20–409] AU/ml). 71% were treated with mycophenolic acid and 100% with steroids in association with belatacept. In contrast, in all the 5 KTRs with prior COVID‐19 history, mRNA vaccine induced a strong antibody response with high antibody titers (median 10 769 AU/ml, IQR [6410–20 069]) after two injections. Seroprevalence after three‐vaccine doses in 35 non‐belatacept‐treated KTRs was 37.1%. Twelve KTRs developed symptomatic COVID‐19 after vaccination, including severe forms (50% of mortality). Breakthrough COVID‐19 occurred in 5% of fully vaccinated patients. Administration of a third dose of BNT162b2 mRNA COVID‐19 vaccine did not improve immunogenicity in KTRs treated with belatacept without prior COVID‐19. Other strategies aiming to improve patient protection are needed. Abstract : Belatacept‐treated kidney transplant recipients without history of COVID‐19 present a weak humoral response after 3 injections of BNT162b2 mRNA COVID‐19 vaccine, contrasting with belatacept‐treated patients with prior COVID‐19 infection for whom mRNA vaccine elicits strong antibody response with high antibody titers after 2 injections.