Stopping of Mycophenolic Acid in Kidney Transplant Recipients for 2 Weeks Peri-Vaccination Does Not Increase Response to SARS-CoV-2 Vaccination—A Non-randomized, Controlled Pilot Study
IntroductionKidney transplant recipients (KTR) are at high risk of developing severe COVID-19. However, vaccine response in this population is severely impaired with humoral response rates of 36–54 and 55–69% after two or three doses of SARS-COV-2 vaccines, respectively. Triple immunosuppression and...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-06-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2022.914424/full |
| _version_ | 1811258232051597312 |
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| author | Florina Regele Andreas Heinzel Karin Hu Lukas Raab Farsad Eskandary Ingrid Faé Sieglinde Zelzer Georg A. Böhmig Gregor Bond Gottfried Fischer Rainer Oberbauer Roman Reindl-Schwaighofer |
| author_facet | Florina Regele Andreas Heinzel Karin Hu Lukas Raab Farsad Eskandary Ingrid Faé Sieglinde Zelzer Georg A. Böhmig Gregor Bond Gottfried Fischer Rainer Oberbauer Roman Reindl-Schwaighofer |
| author_sort | Florina Regele |
| collection | DOAJ |
| description | IntroductionKidney transplant recipients (KTR) are at high risk of developing severe COVID-19. However, vaccine response in this population is severely impaired with humoral response rates of 36–54 and 55–69% after two or three doses of SARS-COV-2 vaccines, respectively. Triple immunosuppression and specifically the use of anti-proliferative agents such as mycophenolic acid (MPA) or azathioprine (AZA) have been identified as risk factors for vaccine hypo-responsiveness.MethodsWe hypothesized that in vaccine non-responders to at least three previous vaccine doses, pausing of MPA or AZA for 1 week before and 1 week after an additional vaccination would improve humoral response rates. We conducted an open-label, non-randomized controlled pilot study including 40 KTR with no detectable humoral response after three or four previous vaccine doses. Primary endpoint was seroconversion following SARS-CoV-2 vaccination. MPA and AZA was paused in 18 patients 1 week before until 1 week after an additional vaccine dose while immunosuppression was continued in 22 patients.ResultsThere was no difference in the humoral response rate between the MPA/AZA pause group and the control group (29 vs. 32%, p > 0.99). Absolute antibody levels were also not statistically significantly different between the two groups (p = 0.716).Renal function in the MPA/AZA pause group remained stable and there was no detection of new onset donor-specific antibodies or an increase of donor-derived cell-free DNA serving as a marker of allograft damage throughout the study period.ConclusionPausing of MPA/AZA for 2 weeks peri-vaccination did not increase the rate of seroconversion in kidney transplant. However, one in three KTR without humoral immune response to at least three previous vaccinations developed antibodies after an additional vaccine dose supporting continued vaccination in non-responders. |
| first_indexed | 2024-04-12T18:11:09Z |
| format | Article |
| id | doaj.art-7ad7e2e4e4234e0d8e620a31bdf480ad |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-04-12T18:11:09Z |
| publishDate | 2022-06-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Medicine |
| spelling | doaj.art-7ad7e2e4e4234e0d8e620a31bdf480ad2022-12-22T03:21:50ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2022-06-01910.3389/fmed.2022.914424914424Stopping of Mycophenolic Acid in Kidney Transplant Recipients for 2 Weeks Peri-Vaccination Does Not Increase Response to SARS-CoV-2 Vaccination—A Non-randomized, Controlled Pilot StudyFlorina Regele0Andreas Heinzel1Karin Hu2Lukas Raab3Farsad Eskandary4Ingrid Faé5Sieglinde Zelzer6Georg A. Böhmig7Gregor Bond8Gottfried Fischer9Rainer Oberbauer10Roman Reindl-Schwaighofer11Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, AustriaDivision of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, AustriaDivision of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, AustriaDivision of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, AustriaDivision of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, AustriaDepartment of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, AustriaClinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, AustriaDivision of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, AustriaDivision of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, AustriaDepartment of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, AustriaDivision of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, AustriaDivision of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, AustriaIntroductionKidney transplant recipients (KTR) are at high risk of developing severe COVID-19. However, vaccine response in this population is severely impaired with humoral response rates of 36–54 and 55–69% after two or three doses of SARS-COV-2 vaccines, respectively. Triple immunosuppression and specifically the use of anti-proliferative agents such as mycophenolic acid (MPA) or azathioprine (AZA) have been identified as risk factors for vaccine hypo-responsiveness.MethodsWe hypothesized that in vaccine non-responders to at least three previous vaccine doses, pausing of MPA or AZA for 1 week before and 1 week after an additional vaccination would improve humoral response rates. We conducted an open-label, non-randomized controlled pilot study including 40 KTR with no detectable humoral response after three or four previous vaccine doses. Primary endpoint was seroconversion following SARS-CoV-2 vaccination. MPA and AZA was paused in 18 patients 1 week before until 1 week after an additional vaccine dose while immunosuppression was continued in 22 patients.ResultsThere was no difference in the humoral response rate between the MPA/AZA pause group and the control group (29 vs. 32%, p > 0.99). Absolute antibody levels were also not statistically significantly different between the two groups (p = 0.716).Renal function in the MPA/AZA pause group remained stable and there was no detection of new onset donor-specific antibodies or an increase of donor-derived cell-free DNA serving as a marker of allograft damage throughout the study period.ConclusionPausing of MPA/AZA for 2 weeks peri-vaccination did not increase the rate of seroconversion in kidney transplant. However, one in three KTR without humoral immune response to at least three previous vaccinations developed antibodies after an additional vaccine dose supporting continued vaccination in non-responders.https://www.frontiersin.org/articles/10.3389/fmed.2022.914424/fullSARS-CoV-2kidney transplantationimmunosuppressantmycophenolateazathioprine |
| spellingShingle | Florina Regele Andreas Heinzel Karin Hu Lukas Raab Farsad Eskandary Ingrid Faé Sieglinde Zelzer Georg A. Böhmig Gregor Bond Gottfried Fischer Rainer Oberbauer Roman Reindl-Schwaighofer Stopping of Mycophenolic Acid in Kidney Transplant Recipients for 2 Weeks Peri-Vaccination Does Not Increase Response to SARS-CoV-2 Vaccination—A Non-randomized, Controlled Pilot Study Frontiers in Medicine SARS-CoV-2 kidney transplantation immunosuppressant mycophenolate azathioprine |
| title | Stopping of Mycophenolic Acid in Kidney Transplant Recipients for 2 Weeks Peri-Vaccination Does Not Increase Response to SARS-CoV-2 Vaccination—A Non-randomized, Controlled Pilot Study |
| title_full | Stopping of Mycophenolic Acid in Kidney Transplant Recipients for 2 Weeks Peri-Vaccination Does Not Increase Response to SARS-CoV-2 Vaccination—A Non-randomized, Controlled Pilot Study |
| title_fullStr | Stopping of Mycophenolic Acid in Kidney Transplant Recipients for 2 Weeks Peri-Vaccination Does Not Increase Response to SARS-CoV-2 Vaccination—A Non-randomized, Controlled Pilot Study |
| title_full_unstemmed | Stopping of Mycophenolic Acid in Kidney Transplant Recipients for 2 Weeks Peri-Vaccination Does Not Increase Response to SARS-CoV-2 Vaccination—A Non-randomized, Controlled Pilot Study |
| title_short | Stopping of Mycophenolic Acid in Kidney Transplant Recipients for 2 Weeks Peri-Vaccination Does Not Increase Response to SARS-CoV-2 Vaccination—A Non-randomized, Controlled Pilot Study |
| title_sort | stopping of mycophenolic acid in kidney transplant recipients for 2 weeks peri vaccination does not increase response to sars cov 2 vaccination a non randomized controlled pilot study |
| topic | SARS-CoV-2 kidney transplantation immunosuppressant mycophenolate azathioprine |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2022.914424/full |
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