Intensity of Mycophenolate Mofetil Treatment is Associated with an Impaired Immune Response to SARS-CoV-2 Vaccination in Kidney Transplant Recipients

Overview

Journal Am J Transplant

Publisher Elsevier

Specialty General Surgery

Date 2021 Sep 22

PMID 34551181

Citations 77

Authors

Marta Kantauskaite

Lisa Muller

Thilo Kolb

Svenja Fischer

Jonas Hillebrandt

Katrin Ivens

Marcel Andree

Tom Luedde

Hans M Orth

Ortwin Adams

Heiner Schaal

Claudia Schmidt

Eva Konigshausen

Lars C Rump

Jorg Timm

Johannes Stegbauer

Affiliations

Soon will be listed here.

Abstract

Kidney transplant recipients (KTRs) are extremely vulnerable to SARS-CoV-2 infection and show an impaired immune response to SARS-CoV-2 vaccination. We analyzed factors related to vaccination efficiency in KTRs. In a multicenter prospective observational study (NCT04743947), IgG antibodies levels against SARS-CoV-2 spike S1 subunit and their neutralization capacity after SARS-CoV-2 vaccination were analyzed in 225 KTRs and compared to 176 controls. After the vaccination, 56 (24.9%) KTRs became seropositive of whom 68% had neutralizing antibodies. This immune response was significantly lower compared to controls (239 [78-519] BAU/ml versus 1826 [560-3180] BAU/ml for KTRs and controls, p < .0001). The strongest predictor for an impaired response was mycophenolate mofetil (MMF) treatment. Multivariate regression analysis revealed that MMF-free regimen was highly associated with seroconversion (OR 13.25, 95% CI 3.22-54.6; p < .001). In contrast, other immunosuppressive drugs had no significant influence. 187 out of 225 KTRs were treated with MMF of whom 26 (13.9%) developed antibodies. 23 of these seropositive KTRs had a daily MMF dose ≤1 g. Furthermore, higher trough MMF concentrations correlated with lower antibody titers (R -0.354, p < .001) supporting a dose-dependent unfavorable effect of MMF. Our data indicate that MMF dose modification could lead to an improved immune response.

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