tetano
Editor, Senior Moderator
J Clin Med
. 2022 Mar 18;11(6):1697.
doi: 10.3390/jcm11061697.
Predictors of Serological Response to SARS-CoV-2 Vaccination in Kidney Transplant Patients: Baseline Characteristics, Immunosuppression, and the Role of IMPDH Monitoring
Lutz Liefeldt[SUP] 1 [/SUP], Petra Glander[SUP] 1 [/SUP], Jens Klotsche[SUP] 2 [/SUP], Henriette Straub-Hohenbleicher[SUP] 1 [/SUP], Klemens Budde[SUP] 1 [/SUP], Bettina Eberspächer[SUP] 3 [/SUP], Frank Friedersdorff[SUP] 4 [/SUP], Fabian Halleck[SUP] 1 [/SUP], Pia Hambach[SUP] 1 [/SUP], Jörg Hofmann[SUP] 3 [/SUP], Nadine Koch[SUP] 1 [/SUP], Danilo Schmidt[SUP] 5 [/SUP], Eva Schrezenmeier[SUP] 1 6 [/SUP], Evelyn Seelow[SUP] 1 [/SUP], Ulrike Weber[SUP] 1 [/SUP], Bianca Zukunft[SUP] 1 [/SUP], Kai-Uwe Eckardt[SUP] 1 [/SUP], Mira Choi[SUP] 1 [/SUP], Friederike Bachmann[SUP] 1 [/SUP], Johannes Waiser[SUP] 1 [/SUP]
Affiliations
Abstract
Immunosuppression increases the risk of severe coronavirus disease 2019 (COVID-19). Morbidity and mortality of this disease in kidney transplant patients are higher than in the general population. As the vaccination response of transplant patients is weak, serological monitoring was performed. In this cohort study, we analyzed the determinants of vaccination response. All patients had no history of COVID-19. With anti-spike IgG monitoring, 148 responders and 415 non-responders were identified. We compared both groups using multivariate analyses of the cohort and a sub-cohort of mycophenolic-acid-treated patients. We investigated the influence of patient characteristics, immunosuppression, and erythrocyte inosine monophosphate dehydrogenase (IMPDH) activity. In responders, the time after transplantation was longer (13.5 vs. 8.5 years), the glomerular filtration rate was higher (56.9 vs. 47.8 mL/min/1.73 m[SUP]2[/SUP]), and responders were younger (53.0 vs. 57.4 years). Heterologous vaccination was more effective than homologous vaccination. Calcineurin inhibitors plus mycophenolate reduced the seroconversion rate. No seroconversion was observed in belatacept patients. In mycophenolate-treated patients, IMPDH activity was a significantly better predictor of response than mycophenolate dose (AUC 0.84 vs. 0.62, p < 0.001). Immunosuppression strongly affects vaccine response. Modifications to immunosuppression should be considered in order to facilitate this response. Erythrocyte IMPDH activity can be used to guide mycophenolate treatment.
Keywords: IMPDH monitoring; SARS-CoV-2 vaccination; immunosuppression; kidney transplantation; serological response.
. 2022 Mar 18;11(6):1697.
doi: 10.3390/jcm11061697.
Predictors of Serological Response to SARS-CoV-2 Vaccination in Kidney Transplant Patients: Baseline Characteristics, Immunosuppression, and the Role of IMPDH Monitoring
Lutz Liefeldt[SUP] 1 [/SUP], Petra Glander[SUP] 1 [/SUP], Jens Klotsche[SUP] 2 [/SUP], Henriette Straub-Hohenbleicher[SUP] 1 [/SUP], Klemens Budde[SUP] 1 [/SUP], Bettina Eberspächer[SUP] 3 [/SUP], Frank Friedersdorff[SUP] 4 [/SUP], Fabian Halleck[SUP] 1 [/SUP], Pia Hambach[SUP] 1 [/SUP], Jörg Hofmann[SUP] 3 [/SUP], Nadine Koch[SUP] 1 [/SUP], Danilo Schmidt[SUP] 5 [/SUP], Eva Schrezenmeier[SUP] 1 6 [/SUP], Evelyn Seelow[SUP] 1 [/SUP], Ulrike Weber[SUP] 1 [/SUP], Bianca Zukunft[SUP] 1 [/SUP], Kai-Uwe Eckardt[SUP] 1 [/SUP], Mira Choi[SUP] 1 [/SUP], Friederike Bachmann[SUP] 1 [/SUP], Johannes Waiser[SUP] 1 [/SUP]
Affiliations
- PMID: 35330022
- DOI: 10.3390/jcm11061697
Abstract
Immunosuppression increases the risk of severe coronavirus disease 2019 (COVID-19). Morbidity and mortality of this disease in kidney transplant patients are higher than in the general population. As the vaccination response of transplant patients is weak, serological monitoring was performed. In this cohort study, we analyzed the determinants of vaccination response. All patients had no history of COVID-19. With anti-spike IgG monitoring, 148 responders and 415 non-responders were identified. We compared both groups using multivariate analyses of the cohort and a sub-cohort of mycophenolic-acid-treated patients. We investigated the influence of patient characteristics, immunosuppression, and erythrocyte inosine monophosphate dehydrogenase (IMPDH) activity. In responders, the time after transplantation was longer (13.5 vs. 8.5 years), the glomerular filtration rate was higher (56.9 vs. 47.8 mL/min/1.73 m[SUP]2[/SUP]), and responders were younger (53.0 vs. 57.4 years). Heterologous vaccination was more effective than homologous vaccination. Calcineurin inhibitors plus mycophenolate reduced the seroconversion rate. No seroconversion was observed in belatacept patients. In mycophenolate-treated patients, IMPDH activity was a significantly better predictor of response than mycophenolate dose (AUC 0.84 vs. 0.62, p < 0.001). Immunosuppression strongly affects vaccine response. Modifications to immunosuppression should be considered in order to facilitate this response. Erythrocyte IMPDH activity can be used to guide mycophenolate treatment.
Keywords: IMPDH monitoring; SARS-CoV-2 vaccination; immunosuppression; kidney transplantation; serological response.