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Abstract: TH-PO933

SARS-CoV-2 Booster Effect and Waning Immunity in Hemodialysis Patients

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Goggins, Eibhlin S,, University of Virginia School of Medicine, Charlottesville, Virginia, United States
  • Sharma, Binu, University of Virginia School of Medicine, Charlottesville, Virginia, United States
  • Ma, Jennie Z., University of Virginia School of Medicine, Charlottesville, Virginia, United States
  • Gautam, Jitendra K., University of Virginia School of Medicine, Charlottesville, Virginia, United States
  • Bowman, Brendan T., University of Virginia School of Medicine, Charlottesville, Virginia, United States
Background

Patients with End Stage Kidney Disease (ESKD) on dialysis are extremely vulnerable to SARS-CoV-2 infection. Antibody levels decline in the months following the standard two-dose vaccination series with Pfizer BioNTech (BNT162b2) mRNA SARS-CoV-2 vaccine in hemodialysis patients. Current guidelines recommend boosters of SARS-CoV-2 mRNA-based vaccines. The aim of this study was to determine the humoral response of hemodialysis patients to a third dose of the BNT162b2 vaccine.

Methods

Prospective cohort study measuring the serologic response of hemodialysis patients to a booster dose of BNT162b2 vaccine at an average of 2, 6 and 11 weeks post vaccination. The Anti-SARS-CoV-2 QuantiVac ELISA (IgG) from Euroimmun (EUROIMMUN US, Inc.) was used in all assessments. Differences in antibody levels over time were compared non-parametrically using the Friedman test, then tested pairwisely with Bonferroni correction at alpha of < 0.05. A linear mixed model was used to estimate the decline in slope after vaccination.

Results

Of 35 hemodialysis patients in the original cohort, 27 (77.1%) received a third dose of BNT162b2. Antibody level significantly increased from pre-booster to 2 weeks post-booster (median (25th, 75th percentile) from 59.94 (29.69, 177.8) to 6216 (3806, 11730)), an average increase of 112 fold. Antibody levels dropped an average of 36.3% to a median of 2654 BAU/mL (1650, 8340) at 6 weeks post-booster. From weeks 6 to 11 post-booster, antibody levels dropped to a median of 1444 BAU/mL (1102, 2020), corresponding to a 52.4% average decrease. Overall, antibody levels declined 47% month to month post-booster. Still, antibody levels at 11 weeks remained an average of 40 fold higher than pre-booster levels. Nine (33%) patients had negative or borderline detectable antibody levels pre-booster and 8 of 9 developed positive (>35.2 BAU/mL) antibody levels post-booster. Those with prior infection had a lower proportional increase in antibody level (51 fold) compared with the median change in COVID naïve patients (144 fold) from pre-booster to 2 weeks post-booster.

Conclusion

Following a third dose of the BNT162b2 vaccine, hemodialysis patients obtain a robust humoral response although antibody levels wane over time.