Immune response, phenotyping and molecular graft surveillance in kidney transplant recipients following severe acute respiratory syndrome coronavirus 2 vaccination

• Published in: Transplant infectious disease Vol. 25; no. 6; pp. e14122 - n/a
• Main Authors: Ali, Nicole M, Herati, Ramin S, Mehta, Sapna A, Leonard, Jeanette, Miles, Jake, Lonze, Bonnie E, DiMaggio, Charles, Tatapudi, Vasishta S, Stewart, Zoe A, Alnazari, Nasser, Neumann, Henry J, Thomas, Jeffrey, Cartiera, Katarzyna, Weldon, Elaina, Michael, Jennifer, Hickson, Christopher, Whiteson, Harris, Khalil, Karen, Stern, Jeffrey M, Allen, Joseph R, Tuen, Michael, Gray‐Gaillard, Sophie L, Solis, Sabrina M, Samanovic, Marie I, Mulligan, Mark J, Montgomery, Robert A
• Format: Journal Article
• Language: English
• Published: Denmark Wiley Subscription Services, Inc 01-12-2023
• Subjects: Alloantibodies; Allografts; Antibodies; Coronaviruses; COVID-19; Deoxyribonucleic acid; DNA; Gene expression; Glomerular filtration rate; graft biomarker; Immune response; Immune system; Immunogenicity; Kidney transplantation; Kidney transplants; Kidneys; Nucleocapsids; Phenotyping; Proteins; Respiratory diseases; SARS‐CoV‐2 vaccination; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Spike protein; Vaccines; Viral diseases; graft biomarker; SARS-CoV-2 vaccination; immunogenicity
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/tid.14122

Background
Understanding immunogenicity and alloimmune risk following severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) vaccination in kidney transplant recipients is imperative to understanding the correlates of protection and to inform clinical guidelines.
Methods
We studied 50 kidney transplant recipients following SARS‐CoV‐2 vaccination and quantified their anti‐spike protein antibody, donor‐derived cell‐free DNA (dd‐cfDNA), gene expression profiling (GEP), and alloantibody formation.
Results
Participants were stratified using nucleocapsid testing as either SARS‐CoV‐2‐naïve or experienced prior to vaccination. One of 34 (3%) SARS‐CoV‐2 naïve participants developed anti‐spike protein antibodies. In contrast, the odds ratio for the association of a prior history of SARS‐CoV‐2 infection with vaccine response was 18.3 (95% confidence interval 3.2, 105.0, p < 0.01). Pre‐ and post‐vaccination levels did not change for median dd‐cfDNA (0.23% vs. 0.21% respectively, p = 0.13), GEP scores (9.85 vs. 10.4 respectively, p = 0.45), calculated panel reactive antibody, de‐novo donor specific antibody status, or estimated glomerular filtration rate.
Conclusions
SARS‐CoV‐2 vaccines do not appear to trigger alloimmunity in kidney transplant recipients. The degree of vaccine immunogenicity was associated most strongly with a prior history of SARS‐CoV‐2 infection.
This single‐center, prospective study illustrated that severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) vaccines do not appear to trigger alloimmunity in kidney transplant recipients. There was no impact of vaccination on cPRA, de novo donor‐specific antibody (dnDSA), or estimated glomerular filtration rate. Serial monitoring with donor‐derived cell‐free DNA, gene expression profiling, and DSA screening provides a novel approach for rejection surveillance following SARS‐CoV‐2 vaccination.