Kidney transplant recipients treated with belatacept have reported suboptimal responses to mRNA COVID-19 vaccine have been reported after two vaccine injections. Nathalie Chavarot, MD, and colleagues performed the humoral response to kidney transplant recipients treated with belatacept without a history of SARS-CoV-2 infection who received three injections of BNT162b2-mRNA COVID-19 vaccine. The analysis also examined vaccine immunogenicity in belatacept-treated kidney transplant recipients with prior COVID-19 and characterized symptomatic COVID-19 infections after vaccine in belatacept-treated kidney transplant recipients.
Of the 62 kidney transplant recipients without a history of COVID-19, 58% were male, and median age was 63.5 years. Of those, only four patients (6.4%) developed anti-SARS-CoV-2 IgG with low antibody titers (median 209 AU/mL); 71% were treated with mycophenolic acid and 100% were treated with steroids in association with belatacept. Conversely, in all five kidney transplant recipients with history of prior COVID-19, mRNA vaccine induced strong antibody response with high antibody titers (median 10769 AU/mL) after two injections.
In 35 kidney transplant recipients not treated with belatacept, seroprevalence after three vaccine doses was 37.1%. Twelve kidney transplant recipients developed symptomatic COVID-19 following vaccination, including severe forms (50% or mortality). Five percent of fully vaccinated patients developed breakthrough COVID-19.
The researchers said, “Administration of a third dose of BNT162b2 mRNA COVID-19 vaccine did not improve immunogenicity in kidney transplant recipients with belatacept without prior COVIS_19. Other strategies aiming to improve patient protection are needed.”