Humoral and cellular immune response to severe acute respiratory syndrome coronavirus-2 vaccination in hemodialysis and kidney transplant patients.

Swai, Joel; Gui, Ming; Long, Mao; Wei, Zhu; Hu, Zixuan; Liu, Shaojun

End-stage renal disease patients are among the vulnerable groups and thus prioritized in the Coronavirus disease-2019 vaccination programs. However, this cohort was excluded from vaccine-trials and yet shares the same vaccination scheme with the general population. Here, we explore trends of immune response-proportions among end-stage renal disease patients on renal replacement therapy for up to four weeks post-vaccination completion with Pfizer/Moderna vaccines. From inception to 10th-July-2021, we searched six online-databases for articles reporting humoral and cellular immune response proportions for up to four weeks post booster-vaccination. We pooled the responders' proportions by meta-analysis and conducted a meta-regression stratifying outcomes by significant confounders. Twenty-seven eligible studies reported 2789 end-stage renal disease patients. 1337, 1452, and 477 were on haemodialysis, received kidney transplantation, and healthy controls, respectively. Haemodialysis patients' proportions of humoral and cellular immune responses varied from 87.29%[80.77-93.81]-88.78%[86.76-90.80] and 62.86%[56.56, 69.17]-85.78%[78.99, 92.57], respectively, between first- and fourth-weeks. Kidney transplant patients' proportions of humoral and cellular immune responses ranged from 2.6%[0.06-13.48]-29.87%[27.68,32.07] and 5.13%[0.63-17.3]-59.84%[54.57-65.10], respectively, between first- and fourth-weeks. All healthy controls maintained ≥93% proportions of both responses throughout the follow-up. Study design and country of study influenced the pooled response proportions. Conclusively, haemodialysis and kidney transplant patients have lower proportions of humoral and cellular immune responses than healthy controls. However, haemodialysis patients' response proportions improve, reaching near healthy-control levels by the fourth week. Kidney transplant patients' lower responses' proportions also improve but remain significantly lower than healthy controls throughout four-weeks. The "one-size-fits-all" vaccination scheme might be inadequate for kidney transplant patients. This article is protected by copyright. All rights reserved.