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COVID-19 Vaccination in Kidney Transplant Candidates and Recipients
Claudio Ponticelli1, Mariarosaria Campise2
1Independent Researcher, 20122 Milan, Italy.
Insights
Kidney transplant patients have a poor COVID-19 vaccine response due to uremic conditions and immunosuppression. This review explores reasons for impaired immunity and potential solutions for kidney transplant recipients.
Area of Science:
- Nephrology
- Immunology
- Infectious Diseases
Background:
- Kidney transplant candidates and recipients (KTRs) face severe COVID-19 complications, with high mortality rates (19-50%) in Western countries.
- COVID-19 vaccination is crucial, but uremic conditions in advanced chronic kidney disease (CKD) and KTRs may impair vaccine-induced immunity.
- Factors like uremic toxins, dysbiosis, dysmetabolism, and dialysis can dysfunction immune cells, reducing vaccine response.
Purpose of the Study:
- To review the primary reasons behind the impaired immunological response to vaccines in kidney transplant candidates and recipients.
- To highlight current strategies and potential solutions to enhance vaccine efficacy in this vulnerable population.
Main Methods:
- This is a review article, synthesizing existing literature on COVID-19 vaccine response in kidney transplant recipients.
- The review focuses on the immunological mechanisms affected by CKD and immunosuppression.
Main Results:
- Over half of KTRs fail to develop an adequate immune response even after multiple vaccine doses.
- Immunosuppressive medications in KTRs further reduce vaccine efficacy.
- Impaired antibody response leaves KTRs at high risk for SARS-CoV-2 infection and severe COVID-19.
Conclusions:
- The compromised immune system in KTRs necessitates strategies to improve vaccine effectiveness.
- Further research is needed to optimize vaccination protocols and therapeutic interventions for KTRs to mitigate COVID-19 risks.
Abstract:
Kidney transplant candidates and kidney transplant recipients (KTRs) are at particular risk of severe complications of COVID-19 disease. In Western countries, mortality in affected hospitalized KTRs ranges between 19% and 50%. COVID-19 vaccination remains the most important measure to prevent the severity of infection in candidates and recipients of kidney transplant. However, the uraemic condition may affect the vaccine-induced immunity in patients with advanced chronic kidney disease (CKD) and in KTRs. Retention of uraemic toxins, dysbiosis, dysmetabolism, and dialysis can diminish the normal response to vaccination, leading to dysfunction of inflammatory and immune cells. In KTRs the efficacy of vaccines may be reduced by the immunosuppressive medications, and more than half of kidney transplant recipients are unable to build an immune response even after four administrations of anti-COVID-19 vaccines. The lack of antibody response leaves these patients at high risk for SARS-CoV-2 infection and severe COVID-19 disease. The aim of the present review is to focus on the main reasons for the impaired immunological response among candidates and kidney transplant recipients and to highlight some of the present options available to solve the problem.
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