Immunogenicity and Reactogenicity After SARS-CoV-2 mRNA Vaccination in Kidney Transplant Recipients Taking Belatacept

• Published in: Transplantation Vol. 105; no. 9; pp. 2119 - 2123
• Main Authors: Ou, Michael T., Boyarsky, Brian J., Chiang, Teresa P.Y., Bae, Sunjae, Werbel, William A., Avery, Robin K., Tobian, Aaron A.R., Massie, Allan B., Segev, Dorry L., Garonzik-Wang, Jacqueline M.
• Format: Journal Article
• Language: English
• Published: Lippincott Williams & Wilkins 01-09-2021
• ISSN: 0041-1337; 1534-6080
• DOI: 10.1097/TP.0000000000003824

BACKGROUNDBelatacept may impair humoral immunity, impacting the effectiveness of SARS-CoV-2 mRNA vaccines in transplant recipients. We investigated immunogenicity after SARS-CoV-2 mRNA vaccines in kidney transplant recipients who are and are not taking belatacept. METHODSParticipants were recruited between December 9, 2020, and April 1, 2021. Blood samples were collected after dose 1 and dose 2 (D1, D2) and analyzed using either an anti-SARS-CoV-2 enzyme immunoassay against the S1 domain of the SARS-CoV-2 spike protein or immunoassay against the receptor-binding domain of the SARS-CoV-2 spike protein. Stabilized inverse probability of treatment weights was used to compare immunogenicity, and a weighted logistics regression was used to calculate fold change of positive response. RESULTSAmong the 609 participants studied, 24 (4%) were taking belatacept. After dose 1, 0/24 (0%) belatacept patients had detectable antibodies, compared with 77 of 568 (14%) among the equivalent nonbelatacept population (P = 0.06). After dose 2, 1/19 (5%) belatacept patients had detectable antibodies, compared with 190/381 (50%) among the equivalent nonbelatacept population (P < 0.001). Belatacept use was associated with 16.7-fold lower odds of having a positive post-D2 titer result (P < 0.01). CONCLUSIONSAdditional measures need to be explored to protect kidney transplant recipients taking belatacept. Best safety practices should be continued despite vaccination among this population.