According to preliminary data, seroconversion after mRNA SARS‐CoV‐2 vaccination might be unsatisfactory in Kidney Transplant Recipients (KTRs). However, it is unknown if seronegative patients develop ...at least a cellular response that could offer a certain grade of protection against SARS‐CoV‐2. To answer this question, we prospectively studied 148 recipients of either kidney (133) or kidney‐pancreas (15) grafts with assessment of IgM/IgG spike (S) antibodies and ELISpot against the nucleocapside (N) and the S protein at baseline and 2 weeks after receiving the second dose of the mRNA‐1273 (Moderna) vaccine. At baseline, 31 patients (20.9%) had either IgM/IgG or ELISpot positivity and were considered to be SARS‐CoV‐2‐pre‐immunized, while 117 (79.1%) patients had no signs of either cellular or humoral response and were considered SARS‐CoV‐2‐naïve. After vaccination, naïve patients who developed either humoral or cellular response were finally 65.0%, of which 29.9% developed either IgG or IgM and 35.0% S‐ELISpot positivity. Factors associated with vaccine unresponsiveness were diabetes and treatment with antithymocytes globulins during the last year. Side effects were consistent with that of the pivotal trial and no DSAs developed after vaccination. In conclusion, mRNA‐1273 SARS‐CoV‐2 vaccine elicits either cellular or humoral response in almost two thirds of KTRs.
Stable kidney or kidney‐pancreas transplant recipients exhibit lower than expected rates of cellular and humoral responses to the
Background.
In kidney transplant recipients, there is discordance between the development of cellular and humoral response after vaccination against SARS-CoV-2. We sought to determine the interplay ...between the 2 arms of adaptive immunity in a 3-dose course of mRNA-1273 100 μg vaccine.
Methods.
Humoral (IgG/IgM) and cellular (N- and S-ELISpot) responses were studied in 117 kidney and 12 kidney-pancreas transplant recipients at the following time points: before the first dose, 14 d after the second dose‚ and before and after the third dose, with a median of 203 and 232 d after the start of the vaccination cycle, respectively.
Results.
After the second dose, 26.7% of naive cases experienced seroconversion. Before the third dose and in the absence of COVID-19, this percentage increased to 61.9%. After the third dose, seroconversion occurred in 80.0% of patients. Naive patients who had at any time point a detectable positivity for S-ELISpot were 75.2% of the population, whereas patients who maintained S-ELISpot positivity throughout the study were 34.3%. S-ELISpot positivity at 42 d was associated with final seroconversion (odds ratio‚ 3.14; 95% confidence interval‚ 1.10-8.96;
P
= 0.032). Final IgG titer was significantly higher in patients with constant S-ELISpot positivity (
P
< 0.001).
Conclusions.
A substantial proportion of kidney transplant recipients developed late seroconversion after 2 doses. Cellular immunity was associated with the development of a stronger humoral response.
Objective: Cardiovascular diseases are the leading cause of mortality and morbidity worldwide. Moreover, chronic kidney disease (CKD) patients exhibit significantly higher incidence and prevalence of ...cardiovascular events. In this population, used to a high burden of pills, the importance of a polypill-based treatment strategy increases to simplify treatment and ensure adherence. The cardiovascular polypill composition includes a lipid-lowering drug, antihypertensive agent, and antiplatelet therapy and is marketed in Spain since 2015 with the name of Trinomia. This report aims to obtain real-life data to evaluate ifTrinomia improves the standard of care. Design and method: Prospective, single-center, observational study of a cohort of CKD patients under the standard of care starting any combination of Trinomia in secondary prevention. Patient demographics, clinical history, blood pressure, and analysis of blood lipids, albumin-to-creatinineratio, and estimated glomerular filtration rate were measured at baseline and 6 and 12 months after starting treatment Results: A total of 49 patients (35 males) were included, with a mean age of 78,83 years (range 51–95). 91,83% had hypertension, 63,26% with type 2 diabetes and 2,04% with type 1 diabetes. Regarding the cause of secondary prevention, 75,4% had cardiovascular disease, 16,4% had a stroke, and 8.16% had both. All laboratory results are displayed in table 1. Conclusions: Although most of the variables studied, probably because it was a small group of patients with adequate baseline control, did not reach statistical significance, some results are worth noting. eGFR is 3 points higher at one year, with a reduction in UACR, which does not reach statistical significance but translates into a lower hyperfiltration without worsening renal function or an increase in serum potassium. In addition, there was a 5-point decrease in systolic blood pressure and a 3-point in diastolic (n.s.), and a better lipid profile is achieved, with a 10-point reduction in LDL and a 24-point reduction in triglycerides.
Background
The age of patients referred for kidney transplantation has increased progressively. However, the precise influence of age on transplant outcomes is controversial.
Methods
Etrospective ...study in which graft and recipient survival were assessed in a cohort of ≥75 years old kidney recipients and compared with a contemporary younger one aged 60-65 years through a propensity score analysis.
Results
We included 106 recipients between 60-65 and 57 patients of ≥75 years old with a median follow-up of 31 13-54 months. Unadjusted one- and five-year recipient survival did not significantly differ between the older (91% and 74%) and the younger group (95% and 82%, P=0.06). In the IPTW weighted Cox regression analysis, recipient age was not associated with an increased risk of death (HR 1.88 95%CI 0.81-4.37, P=0.14). Unadjusted one- and five-year death-censored graft survival did not significantly differ between both groups (96% and 83% for the older and 99% and 89% for the younger group, respectively, P=0.08). After IPTW weighted Cox Regression analysis, recipient age ≥75 years was no associated with an increased risk of graft loss (HR 1.95, 95%CI 0.65-5.82, P=0.23).
Conclusions
These results suggest that recipient age should not be considered itself as an absolute contraindication for kidney transplant
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