Kidney Transplant Recipients Susceptible to COVID-19 Variants Despite Vaccination

Vaccinated kidney transplant recipients show impaired neutralization against emerging COVID-19 variants of concern.

Standard COVID-19 vaccination poorly neutralizes emerging COVID-19 variants in kidney transplant recipients (KTRs), according to new research.

Investigators compared 173 KTRs and 166 healthy individuals who received 2 doses of a COVID-19 vaccine in any combination of mRNA and/or viral vector. They assessed seroconversion by the levels of anti-S1 immunoglobulin G, anti-receptor binding domain, and surrogate neutralizing antibodies. Seroconversion rates were much lower in the transplanted group (30%, 27%, and 24%) than in the control group (100%, 96%, and 100%) for the respective antibodies, Claudius Speer, MD, of the University of Heidelberg in Heidelberg, Germany, and colleagues reported in the Clinical Journal of the American Society of Nephrology.

Investigators also compared antibody responses after the second vaccine dose between 36 kidney transplant recipients and 25 matched healthy individuals who had seroconversion. Everyone showed neutralization activity against the alpha variant (B.1.1.7), but only 64% and 67% of KTRs had activity against the beta (B.1.351) and delta (B.1.617.2) variants, respectively, compared with 100% of healthy individuals.

“Additional vaccinations appear to be required in kidney transplant recipients to maintain high levels of neutralizing antibodies, especially when B.1.617.2 (δ) or other variants with partial escape from neutralizing antibodies become more prevalent,” Dr Speer’s team wrote. The investigators could not assess the relative efficacy of each vaccine regimen due to the small sample sizes.

In an accompanying editorial, Dominique Bertrand, MD, and Sophie Candon, MD, PhD, of Rouen University Hospital in Rouen, France, stated that the study findings argue strongly in favor of a booster dose. “In the absence of seroconversion, the use of anti-SARS-CoV-2 monoclonal antibodies might be the solution to protect this fragile population against the emergence of variants of concern,” they added.

Disclosure: This research was supported by Dietmar Hopp Stiftung. Please see the original reference for a full list of disclosures.


Benning L, Morath C, Bartenschlager M, et al. Neutralization of SARS-CoV-2 variants of concern in kidney transplant recipients after standard COVID-19 vaccination. Clin J Am Soc Nephrol. Published online December 22, 2021. doi:10.2215/CJN.11820921

Bertrand D, Candon S. Protection against SARS-CoV-2 variants with COVID-19 vaccination in kidney transplant recipients. Clin J Am Soc Nephrol. Published online December 22, 2021. doi:10.2215/CJN.14881121

This article originally appeared on Renal and Urology News