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Abstract: TH-PO934

Long-Term Humoral Immunity Decline in Hemodialysis Patients Following SARS-CoV-2 Vaccination

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

Vaccines against SARS-CoV-2 are effective in the general population. Dialysis patients are vulnerable to SARS-CoV-2 infection with high morbidity and mortality. Beginning in January of 2021, the University of Virginia Dialysis Program initiated a program wide vaccination campaign administering Pfizer BioNTech mRNA SARS-CoV-2 (BNT162b2) vaccine. The aim of this study was to characterize the long term time-dependent decline in humoral immunity in hemodialysis patients.

Methods

35 adult hemodialysis patients were recruited to receive two doses of the BNT162b2 vaccine. From 2 to 6 months post vaccination, monthly semi quantitative IgG antibody levels to the SARS-CoV-2 spike protein receptor binding domain were obtained. To analyze the change in antibody levels over time, a linear mixed model with random slope and random intercept was used for longitudinal antibody levels. A multivariable model was used to estimate the slope of antibody levels by adjusting for selected patient characteristics. Based on the estimated intercepts and slopes for each subject from the unadjusted model, 10-month antibody levels were projected.

Results

The mean baseline antibody level was 647.59 BAU/mL and 87.88% (29/33) of patients were considered qualitatively positive. Two patients were negative at baseline and an additional two had borderline results. Patient antibody levels declined at an adjusted average rate of 31% per month. At 6 months post vaccination, 40% of patients remaining in the cohort possessed either negative or borderline IgG antibody levels. Immune suppressed patients, on average, had a 65% lower antibody level compared to patients without immune suppression and patients with prior COVID-19 infection had 5 times higher antibody levels than infection naïve patients. Projecting future antibody levels based on the slopes of antibody level decay suggests 65% of the cohort will progress to borderline or negative antibody levels at 10 months post full vaccination if additional doses are not administered.

Conclusion

The long term vaccine response of hemodialysis patients vaccinated with the BNT162b2 mRNA vaccine was characterized. Our data demonstrates the decline in humoral immunity over time and emphasizes the crucial need for vaccine boosters in this population.