Kidney transplant recipients (KTRs) are extremely vulnerable to SARS-CoV-2 infection and show an impaired immune response to SARS-CoV-2 vaccination. We analyzed factors related to vaccination efficiency in KTRs. In a multicenter prospective observational study (NCT04743947), IgG antibodies levels against SARS-CoV-2 spike S1 subunit and their neutralization capacity after SARS-CoV-2 vaccination were analyzed in 225 KTRs and compared to 176 controls. After the vaccination, 56 (24.9%) KTRs became seropositive of whom 68% had neutralizing antibodies. This immune response was significantly lower compared to controls (239 [78–519] BAU/ml versus 1826 [560–3180] BAU/ml for KTRs and controls, p < .0001). The strongest predictor for an impaired response was mycophenolate mofetil (MMF) treatment. Multivariate regression analysis revealed that MMF-free regimen was highly associated with seroconversion (OR 13.25, 95% CI 3.22–54.6; p < .001). In contrast, other immunosuppressive drugs had no significant influence. 187 out of 225 KTRs were treated with MMF of whom 26 (13.9%) developed antibodies. 23 of these seropositive KTRs had a daily MMF dose ≤1 g. Furthermore, higher trough MMF concentrations correlated with lower antibody titers (R −0.354, p < .001) supporting a dose-dependent unfavorable effect of MMF. Our data indicate that MMF dose modification could lead to an improved immune response.

中文翻译：

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吗替麦考酚酯治疗强度与肾移植受者对 SARS-CoV-2 疫苗接种的免疫反应受损有关


肾移植受者 (KTR) 极易受到 SARS-CoV-2 感染，并且对 SARS-CoV-2 疫苗接种的免疫反应受损。我们分析了与 KTR 疫苗接种效率相关的因素。在一项多中心前瞻性观察研究 (NCT04743947) 中，分析了 225 个 KTR 中针对 SARS-CoV-2 刺突 S1 亚基的 IgG 抗体水平及其在 SARS-CoV-2 疫苗接种后的中和能力，并与 176 个对照进行了比较。接种疫苗后，56 名 (24.9%) KTR 呈血清反应阳性，其中 68% 具有中和抗体。与对照相比，这种免疫反应明显较低（KTR 和对照为 239 [78–519] BAU/ml，而对照为 1826 [560–3180] BAU/ml， p < .0001）。反应受损的最强预测因素是吗替麦考酚酯 (MMF) 治疗。多变量回归分析显示，无 MMF 方案与血清转化高度相关（OR 13.25，95% CI 3.22–54.6； p < .001）。相比之下，其他免疫抑制药物则无显着影响。 225 个 KTR 中有 187 个接受了 MMF 治疗，其中 26 个（13.9%）产生了抗体。其中 23 个血清阳性 KTR 的每日 MMF 剂量≤1 g。此外，较高的 MMF 谷浓度与较低的抗体滴度相关（R -0.354， p < .001），支持 MMF 的剂量依赖性不利影响。我们的数据表明，MMF 剂量调整可以改善免疫反应。