Different antibody responses between liver and kidney transplant recipients elicited by third doses of COVID-19 mRNA vaccines

So Yun Lim; Young-In Yoon; Ji Yeun Kim; Eunyoung Tak; Hyunwook Kwon; Sung Shin; Young Hoon Kim; Gi-Won Song; Sung-Han Kim; Sung-Gyu Lee

doi:10.4285/kjt.22.0056

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Korean J Transplant 2023; 37(1): 49-56

Published online March 31, 2023

https://doi.org/10.4285/kjt.22.0056

Different antibody responses between liver and kidney transplant recipients elicited by third doses of COVID-19 mRNA vaccines

So Yun Lim^1,*, Young-In Yoon^2,*, Ji Yeun Kim^1,*, Eunyoung Tak^3,*, Hyunwook Kwon⁴, Sung Shin⁴, Young Hoon Kim⁴, Gi-Won Song², Sung-Han Kim¹, Sung-Gyu Lee²

¹Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
²Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
³Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology (AMIST), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
⁴Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Correspondence to: Sung-Han Kim
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
E-mail: kimsunghanmd@hotmail.com

Young Hoon Kim
Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
E-mail: gskyh@amc.seoul.kr

Gi-Won Song
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
E-mail: drsong71@amc.seoul.kr

*These authors contributed equally to this work.

Received: November 30, 2022; Revised: January 5, 2023; Accepted: January 7, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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Abstract

Background: Solid organ transplant recipients exhibit decreased antibody responses, mainly due to their weakened immune systems. However, data are limited on antibody responses after the primary series of coronavirus disease 2019 (COVID-19) vaccines among recipients of various solid organ transplant types. Thus, we compared the antibody responses after three COVID-19 vaccine doses between liver transplant (LT) and kidney transplant (KT) recipients.
Methods: We prospectively enrolled solid organ transplant recipients who received three COVID-19 vaccine doses from June 2021 to February 2022 and measured S1-specific immunoglobulin G antibodies using an enzyme-linked immunosorbent assay.
Results: Seventy-six LT and 17 KT recipients were included in the final analysis. KT recipients showed consistently lower antibody responses even after the third vaccine dose (86.2% vs. 52.9%, P=0.008) and lower antibody titers (median, 423.0 IU/mL [interquartile range, 99.6–2,057 IU/mL] vs. 19.7 IU/mL [interquartile range, 6.9–339.4 IU/mL]; P=0.006) than were observed in LT recipients. Mycophenolic acid was a significant risk factor for a seropositive antibody response after the third vaccine dose in the multivariable analysis (odds ratio, 0.06; 95% confidence interval, 0.00–0.39; P=0.02).
Conclusions: We found a weaker antibody response despite the completion of the primary series of COVID-19 vaccines in KT recipients than in LT recipients. Mycophenolic acid use in KT recipients might be the main contributor to this observation.

Keywords: SARS-CoV-2, COVID-19 vaccines, COVID-19 vaccine booster shot, Organ transplantation, Liver transplantation, Kidney transplantation

HIGHLIGHTS
Kidney transplant recipients showed inadequate antibody responses after the coronavirus disease 2019 (COVID-19) primary series. Mycophenolate use was a risk factor for a seronegative antibody response to COVID-19 vaccination. Solid organ transplant recipients showed a heterogeneous distribution of antibody titers after COVID-19 vaccination.