1. Mycophenolate mofetil hampers antibody responses to a broad range of vaccinations in kidney transplant recipients: Results from a randomized controlled study.
- Author
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Fatly, Z. Al, Betjes, M.G.H., Dik, W.A., Fouchier, R.A.M., Reinders, M.E.J., and de Weerd, A.E.
- Abstract
To study the effect of mycophenolate mofetil (MMF) on various vaccination responses in kidney transplant recipients. In a randomized controlled trial (EudraCT nr.: 2014-001372-66), low immunologically risk kidney transplant recipients were randomized to TAC/MMF or TAC-monotherapy (TACmono), six months post-transplantation. One year after transplantation, in a pre-specified sub-study, recipients were vaccinated against pneumococcus, tetanus and influenza. Blood was sampled before and 21 days after vaccination. Adequate vaccination responses were defined by international criteria. A post-hoc analysis was conducted on SARS-CoV-2 vaccination responses within the same cohort. Seventy-one recipients received pneumococcal and tetanus vaccines (TAC/MMF: n = 37, TACmono: n = 34), with 29 also vaccinated against influenza. When vaccinated, recipients were 60 (54–66) years old, with median eGFR of 54 (44–67) ml/min, tacrolimus trough levels 6.1 (5.4–7.0) ug/L in both groups and TAC/MMF daily MMF dose of 1000 (500–2000) mg. Adequate vaccination responses were: pneumococcal (TAC/MMF 43%, TACmono 74%, p = 0.016), tetanus (TAC/MMF 35%, TACmono 82%, p < 0.0001) and influenza (TAC/MMF 20%, TACmono 71%, p = 0.0092). Only 7% of TAC/MMF responded adequately to all three compared to 36% of TACmono (p = 0.080). Additionally, 40% of TAC/MMF responded inadequately to all three, whereas all TACmono patients responded adequately to at least one vaccination (p = 0.041). Lower SARS-CoV-2 vaccination antibody responses correlated with lower pneumococcal antibody vaccination responses (correlation coefficient: 0.41, p = 0.040). MMF on top of tacrolimus severely hampers antibody responses to a broad range of vaccinations. • Serological PPV23 vaccination responses are low in kidney transplant recipients. • Serological tetanus vaccination responses are low in kidney transplant recipients. • Serological influenza vaccination responses are low in kidney transplant recipients. • MMF on top of tacrolimus severely hampers serological vaccination responses. • Discontinuing MMF three months prior to vaccination improves serological responses. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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