Mycophenolate mofetil hampers antibody responses to a broad range of vaccinations in kidney transplant recipients: Results from a randomized controlled study.
J Infect
; 88(3): 106133, 2024 Mar.
Article
em En
| MEDLINE
| ID: mdl-38432583
ABSTRACT
OBJECTIVES:
To study the effect of mycophenolate mofetil (MMF) on various vaccination responses in kidney transplant recipients.METHODS:
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.RESULTS:
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).CONCLUSIONS:
MMF on top of tacrolimus severely hampers antibody responses to a broad range of vaccinations.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Tétano
/
Transplante de Rim
/
Influenza Humana
Limite:
Aged
/
Humans
/
Middle aged
Idioma:
En
Revista:
J Infect
Ano de publicação:
2024
Tipo de documento:
Article
País de publicação:
ENGLAND
/
ESCOCIA
/
GB
/
GREAT BRITAIN
/
INGLATERRA
/
REINO UNIDO
/
SCOTLAND
/
UK
/
UNITED KINGDOM