Assessment of coronavirus disease 2019 mRNA vaccine response in kidney transplant recipients
- 1Department of Medicine, Division of Nephrology, Hamad Medical Corporation, Doha, Qatar
- 2Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
- 3Infectious Disease Epidemiology Group, Weill Cornell Medicine–Qatar, Cornell University, Doha, Qatar
Abstract
Kidney transplant recipients are vulnerable to developing severe coronavirus disease 2019 (COVID-19) infection. Although mRNA vaccines have significantly improved outcomes, seropositivity rates remain variable in immunosuppressed patients. This study aimed to evaluate the antibody response to COVID-19 mRNA vaccines, identify factors affecting immunogenicity, and examine the association between antibody titers and subsequent SARS-CoV-2 infection and COVID-19-related hospitalization among kidney transplant recipients. We retrospectively studied 372 adult kidney transplant recipients who received two doses of COVID-19 mRNA vaccine after transplantation and had anti-SARS‑CoV‑2 spike protein receptor-binding domain antibodies measured ≥ 14 days after the second dose and prior to receiving a third dose. We categorized patients based on previous COVID-19 infection, post-vaccination antibody status (seropositive or seronegative), and antibody titers (low or high). Factors associated with poor vaccine response (seronegativity) and with high antibody titers (antibody titer ≥ 121 U/mL) were determined using multivariable regression models. The proportion of patients with subsequent COVID-19 infection was higher in the seronegative group than in the seropositive or previous infection groups (36% vs. 26% vs. 13%, respectively; P = 0.02). Multivariable regression analysis revealed higher odds of poor response to the mRNA vaccine among patients aged > 52 years compared with those aged ≤ 52 years (aOR = 1.94; 95% CI: 1.12–3.36; P = 0.018). Lower odds were observed among male patients (aOR = 0.43; 95% CI: 0.24–0.77; P = 0.004) and those taking azathioprine (aOR = 0.26; 95% CI: 0.07–0.91; P = 0.035). The proportion of patients with subsequent COVID-19 was also higher in the low-antibody group than in the high-antibody group (33% vs. 20%; P = 0.02). Multivariable logistic regression analysis showed lower odds of high SARS-CoV-2 antibody titers among patients aged > 51 years compared with those aged ≤ 51 years (aOR = 0.43; 95% CI: 0.24–0.75; P = 0.003). Higher odds were observed among those of African race (aOR = 2.82; 95% CI: 1.11–7.16; P = 0.03) and South Asian race (aOR = 2.27; 95% CI: 1.08–4.75; P = 0.03) compared with Middle Eastern recipients. Understanding the immunologic response to the SARS-CoV-2 vaccine in kidney transplant recipients is essential for preventing potentially life-threatening infection. Furthermore, identifying transplant recipients with a low vaccine-induced antibody response may help guide the development of individualized immunization strategies.
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BibTeX
@article{alkadi2026assessment,
title = {{Assessment of coronavirus disease 2019 mRNA vaccine response in kidney transplant recipients}},
author = {Mohamad M. Alkadi and Essa A. Abuhelaiqa and Rasha M. Abdul Rahman and Ali B. Mahgoub and Abdullah I. Hamad and Peter V. Coyle and Zahir M. Tag and Laith J. Abu Raddad and Hassan A. Al-Malki},
journal = {PLOS One},
year = {2026},
month = nov,
doi = {10.1371/journal.pone.0359640},
url = {https://doi.org/10.1371/journal.pone.0359640},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Assessment of coronavirus disease 2019 mRNA vaccine response in kidney transplant recipients
AU - Mohamad M. Alkadi
AU - Essa A. Abuhelaiqa
AU - Rasha M. Abdul Rahman
AU - Ali B. Mahgoub
AU - Abdullah I. Hamad
AU - Peter V. Coyle
AU - Zahir M. Tag
AU - Laith J. Abu Raddad
AU - Hassan A. Al-Malki
PY - 2026
DA - 2026/11/04
JO - PLOS One
DO - 10.1371/journal.pone.0359640
UR - https://doi.org/10.1371/journal.pone.0359640
AB - Kidney transplant recipients are vulnerable to developing severe coronavirus disease 2019 (COVID-19) infection. Although mRNA vaccines have significantly improved outcomes, seropositivity rates remain variable in immunosuppressed patients. This study aimed to evaluate the antibody response to COVID-19 mRNA vaccines, identify factors affecting immunogenicity, and examine the association between antibody titers and subsequent SARS-CoV-2 infection and COVID-19-related hospitalization among kidney transplant recipients. We retrospectively studied 372 adult kidney transplant recipients who received two doses of COVID-19 mRNA vaccine after transplantation and had anti-SARS‑CoV‑2 spike protein receptor-binding domain antibodies measured ≥ 14 days after the second dose and prior to receiving a third dose. We categorized patients based on previous COVID-19 infection, post-vaccination antibody status (seropositive or seronegative), and antibody titers (low or high). Factors associated with poor vaccine response (seronegativity) and with high antibody titers (antibody titer ≥ 121 U/mL) were determined using multivariable regression models. The proportion of patients with subsequent COVID-19 infection was higher in the seronegative group than in the seropositive or previous infection groups (36% vs. 26% vs. 13%, respectively; P = 0.02). Multivariable regression analysis revealed higher odds of poor response to the mRNA vaccine among patients aged > 52 years compared with those aged ≤ 52 years (aOR = 1.94; 95% CI: 1.12–3.36; P = 0.018). Lower odds were observed among male patients (aOR = 0.43; 95% CI: 0.24–0.77; P = 0.004) and those taking azathioprine (aOR = 0.26; 95% CI: 0.07–0.91; P = 0.035). The proportion of patients with subsequent COVID-19 was also higher in the low-antibody group than in the high-antibody group (33% vs. 20%; P = 0.02). Multivariable logistic regression analysis showed lower odds of high SARS-CoV-2 antibody titers among patients aged > 51 years compared with those aged ≤ 51 years (aOR = 0.43; 95% CI: 0.24–0.75; P = 0.003). Higher odds were observed among those of African race (aOR = 2.82; 95% CI: 1.11–7.16; P = 0.03) and South Asian race (aOR = 2.27; 95% CI: 1.08–4.75; P = 0.03) compared with Middle Eastern recipients. Understanding the immunologic response to the SARS-CoV-2 vaccine in kidney transplant recipients is essential for preventing potentially life-threatening infection. Furthermore, identifying transplant recipients with a low vaccine-induced antibody response may help guide the development of individualized immunization strategies.
SN - 1932-6203
ER -