Following regular COVID-19 vaccination, most kidney transplant recipients do not develop robust neutralizing antibody responses to beta and delta variants.

According to the research published in CJASN, kidney transplant recipients have reduced antibody responses against developing SARS-CoV-2 variants after conventional two-dose COVID-19 vaccination.

Even transplant recipients with identifiable antibody responses against the original SARS-CoV-2 strain in commercially accessible testing are at risk.

SARS-CoV-2 immunization is strongly advised in kidney transplant patients as they are at high risk of SARS-CoV-2 infection and more severe COVID-19 disease. However, studies show that kidney transplant recipients had poorer antibody responses to SARS-CoV-2 immunization than healthy people.

When SARS-CoV-2 wildtype and B.1.1.7 (alpha) strains were the most common variants, many of these studies were done. It isn’t clear if the findings apply to the current situation with B.1.351 (beta) and B.1.617.2 (delta) variants of concern.

To find out, a team led by Claudius Speer, MD (Heidelberg University Hospital, Germany) undertook a prospective two-center trial between December 2020 and June 2021 that included 173 kidney transplant recipients and 166 healthy controls who were given different SARS-CoV-2 immunization schedules.

SARS-CoV-2 neutralizing antibodies were found in fewer kidney transplant recipients than in healthy controls after vaccination. Anti-S1, anti-receptor-binding domain, and surrogate neutralizing antibodies—all separate types of antibodies against specific elements of SARS-CoV-2—were identified in 30 percent, 27 percent, and 24 percent of kidney transplant recipients, respectively, after the second vaccine dosage. This compares to 100 percent, 96 percent, and 100 percent in healthy controls, respectively.

Neutralization against B.1.1.7 (alpha) was found in all 36 of the 173 kidney transplant recipients who developed antibody responses against the original SARS-CoV-2 strain.

When these 36 kidney transplant recipients were examined for antibody responses to developing variations after immunization, only 64 percent and 67 percent demonstrated neutralization against B.1.351 (beta) and B.1.617.2 (delta), respectively.

Neutralization against various variants was much higher in healthy controls, with all participants exhibiting neutralization against all variants examined.

“We discovered that a large proportion of kidney transplant recipients is not adequately protected against the emerging variants B.1.351 (beta) and B.1.617.2 (delta) with the standard vaccination regimens currently used in the healthy general population,” Dr. Speer said.

“Additional vaccinations appear to be required in kidney transplant recipients to maintain high levels of neutralizing antibodies, especially when B.1.617.2 (delta) or other variants with partial escape from neutralizing antibodies are prevalent.”

“In the absence of seroconversion, the use of anti SARS-CoV-2 monoclonal antibodies might be the solution to protect this fragile population against the emergence of variants of concern,” the authors added.

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