MMF/MPA Is the Main Mediator of a Delayed Humoral Response With Reduced Antibody Decline in Kidney Transplant Recipients After SARS-CoV-2 mRNA Vaccination
Kidney transplant recipients (KTR) show significantly lower seroconversion rates after SARS-CoV-2 mRNA vaccination compared to dialysis patients (DP). Mycophenolate mofetil or mycophenolic acid (MMF/MPA) in particular has been identified as a risk factor for seroconversion failure. While the majorit...
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| Language: | English |
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Frontiers Media S.A.
2022-07-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2022.928542/full |
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| author | Julian Stumpf Julian Stumpf Torsten Siepmann Jörg Schwöbel Grit Glombig Alexander Paliege Anne Steglich Florian Gembardt Friederike Kessel Hannah Kröger Patrick Arndt Jan Sradnick Kerstin Frank Anna Klimova René Mauer Torsten Tonn Torsten Tonn Christian Hugo Christian Hugo |
| author_facet | Julian Stumpf Julian Stumpf Torsten Siepmann Jörg Schwöbel Grit Glombig Alexander Paliege Anne Steglich Florian Gembardt Friederike Kessel Hannah Kröger Patrick Arndt Jan Sradnick Kerstin Frank Anna Klimova René Mauer Torsten Tonn Torsten Tonn Christian Hugo Christian Hugo |
| author_sort | Julian Stumpf |
| collection | DOAJ |
| description | Kidney transplant recipients (KTR) show significantly lower seroconversion rates after SARS-CoV-2 mRNA vaccination compared to dialysis patients (DP). Mycophenolate mofetil or mycophenolic acid (MMF/MPA) in particular has been identified as a risk factor for seroconversion failure. While the majority of all KTR worldwide receive MMF/MPA for immunosuppressive therapy, its impact on antibody decline in seroconverted KTR still remains unclear. In an observational study (NCT04799808), we investigated whether 132 seroconverted KTR (anti-spike S1 IgG or IgA positive after 2 vaccinations) show a more rapid antibody decline with MMF/MPA than those without this medication. A total of 2 months after mRNA vaccination, average anti-spike S1 IgG levels of KTR with MMF/MPA were lower than without (p = 0.001), while no differences between these two groups were observed after 6 months (p = 0.366). Similar results were obtained for anti-RBD IgG antibodies (T2 p = 0.003 and T3 p = 0.135). The probability of severe IgG decline with MMF/MPA was three times lower than without (p = 0.003, OR 0.236, 95% CI 0.091–0.609). In the multivariate analysis, neither immunosuppressants, such as calcineurin inhibitors, mTOR inhibitors (mTOR-I; mechanistic target of rapamycin), glucocorticoids, nor vaccine type, sex, or age showed a significant influence on IgG titer decline between 2 and 6 months. For the decision on additional booster vaccinations, we consider immunosurveillance to be needed as an integral part of renal transplant follow-up after SARS-CoV-2 mRNA vaccination. Not only the lack of seroconversion but also the peak and titer decline of the specific IgG and RBD IgG antibody formation after two mRNA vaccinations is significantly influenced by MMF/MPA. |
| first_indexed | 2024-04-13T14:41:21Z |
| format | Article |
| id | doaj.art-4039a82b05374e4c8c8336411ca350f4 |
| institution | Directory Open Access Journal |
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| language | English |
| last_indexed | 2024-04-13T14:41:21Z |
| publishDate | 2022-07-01 |
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| series | Frontiers in Medicine |
| spelling | doaj.art-4039a82b05374e4c8c8336411ca350f42022-12-22T02:42:53ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2022-07-01910.3389/fmed.2022.928542928542MMF/MPA Is the Main Mediator of a Delayed Humoral Response With Reduced Antibody Decline in Kidney Transplant Recipients After SARS-CoV-2 mRNA VaccinationJulian Stumpf0Julian Stumpf1Torsten Siepmann2Jörg Schwöbel3Grit Glombig4Alexander Paliege5Anne Steglich6Florian Gembardt7Friederike Kessel8Hannah Kröger9Patrick Arndt10Jan Sradnick11Kerstin Frank12Anna Klimova13René Mauer14Torsten Tonn15Torsten Tonn16Christian Hugo17Christian Hugo18Medizinische Klinik und Poliklinik III, Universitätsklinikum, Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyKfH-Nierenzentrum Dresden, Dresden, GermanyKfH-Nierenzentrum am Klinikum Chemnitz, Krankenhaus Küchwald, Chemnitz, GermanyDialysezentrum Chemnitz, Chemnitz, GermanyKfH-Nierenzentrum am Klinikum St. Georg, Leipzig, GermanyMedizinische Klinik und Poliklinik III, Universitätsklinikum, Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyMedizinische Klinik und Poliklinik III, Universitätsklinikum, Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyMedizinische Klinik und Poliklinik III, Universitätsklinikum, Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyMedizinische Klinik und Poliklinik III, Universitätsklinikum, Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyMedizinische Klinik und Poliklinik III, Universitätsklinikum, Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyMedizinische Klinik und Poliklinik III, Universitätsklinikum, Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyMedizinische Klinik und Poliklinik III, Universitätsklinikum, Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyInstitut für Transfusionsmedizin Plauen, DRK-Blutspendedienst Nord-Ost gemeinnützige GmbH, Plauen, GermanyNational Center for Tumor Diseases (NCT) Dresden, Dresden, GermanyFaculty of Medicine Carl Gustav Carus, Institute for Medical Informatics and Biometry (IMB), Technische Universität Dresden, Dresden, GermanyInstitute for Transfusion Medicine, German Red Cross Blood Donation Service North-East, Dresden, Germany0Faculty of Medicine Carl Gustav Carus, Transfusion Medicine, Technische Universität Dresden, Dresden, GermanyMedizinische Klinik und Poliklinik III, Universitätsklinikum, Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyKfH-Nierenzentrum Dresden, Dresden, GermanyKidney transplant recipients (KTR) show significantly lower seroconversion rates after SARS-CoV-2 mRNA vaccination compared to dialysis patients (DP). Mycophenolate mofetil or mycophenolic acid (MMF/MPA) in particular has been identified as a risk factor for seroconversion failure. While the majority of all KTR worldwide receive MMF/MPA for immunosuppressive therapy, its impact on antibody decline in seroconverted KTR still remains unclear. In an observational study (NCT04799808), we investigated whether 132 seroconverted KTR (anti-spike S1 IgG or IgA positive after 2 vaccinations) show a more rapid antibody decline with MMF/MPA than those without this medication. A total of 2 months after mRNA vaccination, average anti-spike S1 IgG levels of KTR with MMF/MPA were lower than without (p = 0.001), while no differences between these two groups were observed after 6 months (p = 0.366). Similar results were obtained for anti-RBD IgG antibodies (T2 p = 0.003 and T3 p = 0.135). The probability of severe IgG decline with MMF/MPA was three times lower than without (p = 0.003, OR 0.236, 95% CI 0.091–0.609). In the multivariate analysis, neither immunosuppressants, such as calcineurin inhibitors, mTOR inhibitors (mTOR-I; mechanistic target of rapamycin), glucocorticoids, nor vaccine type, sex, or age showed a significant influence on IgG titer decline between 2 and 6 months. For the decision on additional booster vaccinations, we consider immunosurveillance to be needed as an integral part of renal transplant follow-up after SARS-CoV-2 mRNA vaccination. Not only the lack of seroconversion but also the peak and titer decline of the specific IgG and RBD IgG antibody formation after two mRNA vaccinations is significantly influenced by MMF/MPA.https://www.frontiersin.org/articles/10.3389/fmed.2022.928542/fullvaccinationkidney transplant recipientsSARS-CoV-2humoral responsemycophenolic acidclinical decision making |
| spellingShingle | Julian Stumpf Julian Stumpf Torsten Siepmann Jörg Schwöbel Grit Glombig Alexander Paliege Anne Steglich Florian Gembardt Friederike Kessel Hannah Kröger Patrick Arndt Jan Sradnick Kerstin Frank Anna Klimova René Mauer Torsten Tonn Torsten Tonn Christian Hugo Christian Hugo MMF/MPA Is the Main Mediator of a Delayed Humoral Response With Reduced Antibody Decline in Kidney Transplant Recipients After SARS-CoV-2 mRNA Vaccination Frontiers in Medicine vaccination kidney transplant recipients SARS-CoV-2 humoral response mycophenolic acid clinical decision making |
| title | MMF/MPA Is the Main Mediator of a Delayed Humoral Response With Reduced Antibody Decline in Kidney Transplant Recipients After SARS-CoV-2 mRNA Vaccination |
| title_full | MMF/MPA Is the Main Mediator of a Delayed Humoral Response With Reduced Antibody Decline in Kidney Transplant Recipients After SARS-CoV-2 mRNA Vaccination |
| title_fullStr | MMF/MPA Is the Main Mediator of a Delayed Humoral Response With Reduced Antibody Decline in Kidney Transplant Recipients After SARS-CoV-2 mRNA Vaccination |
| title_full_unstemmed | MMF/MPA Is the Main Mediator of a Delayed Humoral Response With Reduced Antibody Decline in Kidney Transplant Recipients After SARS-CoV-2 mRNA Vaccination |
| title_short | MMF/MPA Is the Main Mediator of a Delayed Humoral Response With Reduced Antibody Decline in Kidney Transplant Recipients After SARS-CoV-2 mRNA Vaccination |
| title_sort | mmf mpa is the main mediator of a delayed humoral response with reduced antibody decline in kidney transplant recipients after sars cov 2 mrna vaccination |
| topic | vaccination kidney transplant recipients SARS-CoV-2 humoral response mycophenolic acid clinical decision making |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2022.928542/full |
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