Vaccine Efficacy and Safety in People with Kidney Diseases/Kidney Transplant Recipients

A special issue of Vaccines (ISSN 2076-393X). This special issue belongs to the section "Vaccine Efficacy and Safety".

Deadline for manuscript submissions: 31 January 2025 | Viewed by 1745

Special Issue Editor


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Guest Editor
Department of Nephrology, Heidelberg University Hospital, 69120 Heidelberg, Germany
Interests: immunology; nephrology; vaccination; kidney transplantation; chronic kidney disease

Special Issue Information

Dear Colleagues,

The COVID-19 pandemic unmasked the impact of extrinsic immunosuppression, as in kidney transplant recipients, or intrinsic immunosuppression, as in ESRD patients with chronic inflammation and immune senescence with exceptionally high lethality. Immunocompromised cohorts with kidney diseases (e.g., hemodialysis patients, peritoneal dialysis patients, kidney transplant recipients, patients with systemic autoimmune diseases etc.) have a significantly impaired SARS-CoV-2 vaccine response compared with healthy subjects, even to new mRNA vaccines. Major efforts have been made to increase humoral and cellular immunity, even against variants with immune escape, via different booster vaccinations. These include mRNA vaccines, as well as heterologous vaccination regimens. During the last year, a decisive contribution has been made to protect particularly vulnerable patient collectives from severe COVID-19 courses as effectively, safely, and promptly as possible. In addition, knowledge from different COVID-19 vaccine trials is valuable for the role it plays in generating information for optimizing the effectiveness of vaccination in collectives with kidney diseases beyond the COVID-19 pandemic.

The initial mRNA vaccines were based on the original SARS-CoV-2 strain. With the upcoming different Omicron variants characterized by immune escape, novel vaccination strategies, including adapted mRNA vaccines against epitopes of emerging variants, are needed to protect high-risk individuals. However, further research is needed to fully understand the efficacy and safety of these bivalent vaccines against emerging variants. This Special Issue specifically welcomes (1) the submission of manuscripts that address efficacy, immunogenicity, and long-term immune response after bivalent COVID-19 vaccination, and (2) studies of non-COVID-19 vaccines that examine humoral and cellular immunity to various vaccines in immunocompromised individuals with kidney disease.

Dr. Claudius Speer
Guest Editor

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Keywords

  • vaccines
  • mRNA vaccines
  • kidney transplant recipients
  • immunosuppression
  • biomarkers
  • dialysis

Published Papers (2 papers)

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Research

11 pages, 1873 KiB  
Article
Durability of Humoral Responses after an Adapted SARS-CoV-2 mRNA Vaccine Dose in Hemodialysis Patients
by Louise Benning, Marie Bartenschlager, Heeyoung Kim, Christian Morath, Martin Zeier, Paul Schnitzler, Ralf Bartenschlager and Claudius Speer
Vaccines 2024, 12(7), 738; https://doi.org/10.3390/vaccines12070738 - 3 Jul 2024
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Abstract
We recently showed that an adapted SARS-CoV-2 vaccine with wildtype and BA.4/BA.5 Omicron subtype epitopes induced a broad short-term immune response in hemodialysis patients. Antibodies with protective capacity were boosted significantly after a follow-up period of 3 weeks following a fifth vaccine dose. [...] Read more.
We recently showed that an adapted SARS-CoV-2 vaccine with wildtype and BA.4/BA.5 Omicron subtype epitopes induced a broad short-term immune response in hemodialysis patients. Antibodies with protective capacity were boosted significantly after a follow-up period of 3 weeks following a fifth vaccine dose. However, data on the longevity of the humoral response after bivalent vaccination are lacking but urgently needed to make recommendations for further booster vaccinations in this patient group. This study is an extension of our previously published data including 40 patients on hemodialysis with a follow-up period of 12 months after an adapted booster vaccine dose. We performed a detailed characterization of humoral immune responses and assessed breakthrough infections. In addition, the severity of breakthrough infections was assessed using an established grading system. Anti-S1 IgG and surrogate neutralizing antibodies significantly decreased during the period of 12 months (p < 0.01 and p < 0.001, respectively). Live-virus neutralizing antibodies against the wildtype and the BA.5 subtype also significantly decreased over time (p < 0.01 and p < 0.01, respectively). However, even 12 months after administration of the adapted vaccine dose, all 40/40 (100%) of hemodialysis patients showed detectable SARS-CoV-2 wildtype neutralization activity, with 35/40 (88%) also exhibiting detectable BA.5 subtype neutralization activity. During follow-up, 13/40 (33%) patients contracted a SARS-CoV-2 breakthrough infection, among which 12 cases were categorized as asymptomatic or mild, while only 1 case was classified as moderate disease activity. Thus, bivalent booster vaccination seems to induce a sustained immune response in hemodialysis patients over a period of 12 months with breakthrough infections occurring frequently but predominantly manifesting as asymptomatic or mild. Full article
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20 pages, 7054 KiB  
Article
Dietary Inulin to Improve SARS-CoV-2 Vaccine Response in Kidney Transplant Recipients: The RIVASTIM-Inulin Randomised Controlled Trial
by Julian Singer, Matthew J. Tunbridge, Bree Shi, Griffith B. Perkins, Cheng Sheng Chai, Tania Salehi, Beatrice Z. Sim, Svjetlana Kireta, Julie K. Johnston, Anouschka Akerman, Vanessa Milogiannakis, Anupriya Aggarwal, Stuart Turville, Pravin Hissaria, Tracey Ying, Huiling Wu, Branka Grubor-Bauk, P. Toby Coates and Steven J. Chadban
Vaccines 2024, 12(6), 608; https://doi.org/10.3390/vaccines12060608 - 3 Jun 2024
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Abstract
Kidney transplant recipients are at an increased risk of hospitalisation and death from SARS-CoV-2 infection, and standard two-dose vaccination schedules are typically inadequate to generate protective immunity. Gut dysbiosis, which is common among kidney transplant recipients and known to effect systemic immunity, may [...] Read more.
Kidney transplant recipients are at an increased risk of hospitalisation and death from SARS-CoV-2 infection, and standard two-dose vaccination schedules are typically inadequate to generate protective immunity. Gut dysbiosis, which is common among kidney transplant recipients and known to effect systemic immunity, may be a contributing factor to a lack of vaccine immunogenicity in this at-risk cohort. The gut microbiota modulates vaccine responses, with the production of immunomodulatory short-chain fatty acids by bacteria such as Bifidobacterium associated with heightened vaccine responses in both observational and experimental studies. As SCFA-producing populations in the gut microbiota are enhanced by diets rich in non-digestible fibre, dietary supplementation with prebiotic fibre emerges as a potential adjuvant strategy to correct dysbiosis and improve vaccine-induced immunity. In a randomised, double-bind, placebo-controlled trial of 72 kidney transplant recipients, we found dietary supplementation with prebiotic inulin for 4 weeks before and after a third SARS-CoV2 mRNA vaccine to be feasible, tolerable, and safe. Inulin supplementation resulted in an increase in gut Bifidobacterium, as determined by 16S RNA sequencing, but did not increase in vitro neutralisation of live SARS-CoV-2 virus at 4 weeks following a third vaccination. Dietary fibre supplementation is a feasible strategy with the potential to enhance vaccine-induced immunity and warrants further investigation. Full article
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