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Kidney Week

Abstract: FR-PO1103

Longitudinal SARS-CoV-2 Antibody and T-Cell Immune Responses in Patients on Hemodialysis During the Omicron Era

Session Information

  • COVID-19 - II
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Karaba, Andrew H., Johns Hopkins University, Baltimore, Maryland, United States
  • Xue, Jiashu, Johns Hopkins University, Baltimore, Maryland, United States
  • Johnston, Trevor Scott, Johns Hopkins University, Baltimore, Maryland, United States
  • Traut, Caroline, Johns Hopkins University, Baltimore, Maryland, United States
  • Blankson, Joel, Johns Hopkins University, Baltimore, Maryland, United States
  • Parikh, Chirag R., Johns Hopkins University, Baltimore, Maryland, United States
  • Ray, Stuart C., Johns Hopkins University, Baltimore, Maryland, United States
Background

Individuals receiving renal replacement therapy via hemodialysis (HD) are at high risk for severe outcomes from COVID-19, have attenuated responses to the original COVID-19 vaccine series, and are at increased risk for contracting SARS-CoV-2 due to frequent healthcare exposures. How immunity to SARS-CoV-2, and risk for severe disease, evolve with episodes of infection and additional booster vaccinations in this vulnerable population has not been described.

Methods

An observational multicenter cohort of 55 HD patients (>90% received at least two doses of mRNA COVID-19 vaccine, 56% female, 47% with diabetic kidney disease, age [med, IQR] 67, 58-74 years) were followed for 24 weeks between Dec 2021 and Nov 2022 and provided blood samples at enrollment (week 0), 8 weeks, and 24 weeks. Plasma was tested for anti-SARS-CoV-2 IgG and ACE2 inhibition (surrogate neutralization; 0-100% with >25% consistent with neutralizing antibody) against ancestral, Beta, Delta, and Omicron subvariants using the MSD platform. T cell responses to SARS-CoV-2 spike and nucleocapsid were assessed via ELISpot. Changes in antibody and T cell responses were assessed by paired Wilcoxon rank-sum testing. Additionally, responses were compared to boosted healthy controls (HC) (n=11).

Results

Antibody responses against ancestral virus remained relatively constant in the HD cohort (p = 0.9). Neutralization of BA.5 remained low throughout with 48% of participants below the 25% threshold associated with live-virus neutralization. While ACE2 inhibition was similar to HCs (Figure), the proportion of HD participants above the 25% threshold for BA.5 was significantly lower than HCs (p = 0.004). Neutralizing capacity of BA.5 among HD patients with a history of COVID-19 was not greater than those with no history of COVID-19. Spike specific T cell responses increased in HD patients over time.

Conclusion

Original vaccine formulations are insufficient to induce reliable Omicron subvariant neutralization in HD patients.

Funding

  • Commercial Support – This work was supported by Fresenius Medical Care