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Abstract: PO0127

Antibody and T Cell Reactivity Response After SARS-CoV-2 BNT162b2 mRNA Vaccine in Hemodialysis Patients: A Single-Center Experience from Sweden

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Melin, Jan, Akademiska sjukhuset, Uppsala, Sweden
  • Svensson, Maria K., Akademiska sjukhuset, Uppsala, Sweden
  • Albinsson, Bo, Akademiska sjukhuset, Uppsala, Sweden
  • Pauksens, Karlis, Akademiska sjukhuset, Uppsala, Sweden
Background

The immune system is affected by uremia. Patients with end-stage kidney disease (ESKD) on hemodialysis treatment (HD) are vulnerable to infections, may have suboptimal response to vaccination and are at increased risk of contagious infections due to many health care contacts. They also have a high mortality from Covid-19 infection.

Methods

In 50 patients (mean age 69.4 years, 62% men) with ESKD and HD at Uppsala Academic Hospital, Sweden, administration of vaccine began in late Dec 2020 and the immune response was followed up four months later, in April/May 2021. IgG antibody test against Covid-19 (SARS-CoV-2) was performed against the nucleocapsid antigen (anti-N), positive only after illness, and against Spike antigen (anti-S) positive both after illness and after vaccination (quantitative method in routine diagnostics at the department of microbiology, Uppsala). T-cell reactivity testing against the Spike protein using ELISPOT technology measuring Interferon-gamma activity was performed at ABC-labs, Solna.

Results

Out of 50 patients IgG antibodies to anti-S were detected in 37 (74%), 5 (10%) had a limit response and 8 (16%) were negative after two doses of vaccine. T-cell responses were detected in 29 (58%) and in 21 (42%) no response was detected. Of the 37 patients with antibody responses to anti-S, 25 (68%) also had a measurable T-cell response, 2 (40%) of 5 with limit value for antibody response and 2 (25%) of 8 had no antibody response. 27 (54%) had both an antibody and T-cell reactivity response. IgG antibodies to anti-N indicating a previous Covid-19 disease after 2 doses of vaccine were detected in 7 (14%) patients. 3 patients (6%) had tested PCR-Covid-19 positive before vaccination, 2 (4%) became positive between doses one and two. 4 (8%) had positive tests after two injections and all of them developed a mild disease.

Conclusion

A majority of patients with ESKD and HD develop a B- and/or T-cell response after vaccination against Covid-19 but approx. 20 % had a very limited immunological response. In a clinical setting it is justified to measure the antibody response after vaccination to identify patients are not protected and where to need to take other measures to protect them from infection. In these patients, a third vaccine dose with another type of vaccine could be justifyable.

Funding

  • Clinical Revenue Support