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

Abstract

AbstractBackgroundUnderstanding 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.MethodsWe 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.ResultsParticipants 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.ConclusionsSARS‐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. image