AUTHOR=Yahav Dafna , Rahamimov Ruth , Mashraki Tiki , Ben-Dor Naomi , Steinmetz Tali , Agur Timna , Zingerman Boris , Herman-Edelstein Michal , Lichtenberg Shelly , Ben-Zvi Haim , Bar-Haim Erez , Cohen Hila , Rotem Shahar , Elia Uri , Margalit Ili , Zvi Benaya Rozen 

TITLE=Immune Response to Third Dose BNT162b2 COVID-19 Vaccine Among Kidney Transplant Recipients—A Prospective Study

JOURNAL=Transplant International

VOLUME=Volume 35 - 2022

YEAR=2022

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2022.10204

DOI=10.3389/ti.2022.10204

ISSN=1432-2277

ABSTRACT=Immune response to two SARS-CoV-2 mRNA vaccine doses among kidney transplant recipients (KTRs) is limited. We aimed to evaluate humoral and cellular response to a third BNT162b2 dose. In this prospective study, 190 KTRs were evaluated before and ~3 weeks after third vaccine dose. The primary outcomes were anti-spike antibody level > 4160 AU/ml (neutralization-associated cutoff) and any seropositivity. Univariate and multivariate analyses were conducted to identify variables associated with antibody response. T-cell response was evaluated in a subset of participants. Results were compared to 56 healthcare workers controls. Among KTRs, we found a seropositivity rate of 70% (133/190) after third dose (37%, 70/190, after second vaccine dose); and 27% (52/190) achieved levels above 4160 AU/ml after the third dose, compared to 93% of controls. Variables associated with antibody response included higher antibody levels after the second dose (odds ratio [OR] 30.8 per log AU/ml, 95% confidence interval [CI]11-86.4, p<0.001); and discontinuation of antimetabolite prior to vaccination (OR 9.1 ,95% CI 1.8-46.5, p=0.008). T-cell response was demonstrated in 13% (7/53). In conclusion, third dose BNT162b2 improved immune response among KTRs, however still 30% remain seronegative. Pre-vaccination temporary immunosuppression reduction improved antibody response.