Immune Response to Third Dose BNT162b2 COVID-19 Vaccine Among Kidney Transplant Recipients—A Prospective Study

Dafna Yahav*, Ruth Rahamimov, Tiki Mashraki, Naomi Ben-Dor, Tali Steinmetz, Timna Agur, Boris Zingerman, Michal Herman-Edelstein, Shelly Lichtenberg, Haim Ben-Zvi, Erez Bar-Haim, Hila Cohen, Shahar Rotem, Uri Elia, Ili Margalit, Benaya Rozen Zvi

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Immune response to two SARS-CoV-2 mRNA vaccine doses among kidney transplant recipients (KTRs) is limited. We aimed to evaluate humoral and cellular response to a third BNT162b2 dose. In this prospective study, 190 KTRs were evaluated before and ∼3 weeks after the third vaccine dose. The primary outcomes were anti-spike antibody level >4160 AU/ml (neutralization-associated cutoff) and any seropositivity. Univariate and multivariate analyses were conducted to identify variables associated with antibody response. T-cell response was evaluated in a subset of participants. Results were compared to a control group of 56 healthcare workers. Among KTRs, we found a seropositivity rate of 70% (133/190) after the third dose (37%, 70/190, after the second vaccine dose); and 27% (52/190) achieved levels above 4160 AU/ml after the third dose, compared to 93% of controls. Variables associated with antibody response included higher antibody levels after the second dose (odds ratio [OR] 30.8 per log AU/ml, 95% confidence interval [CI]11–86.4, p < 0.001); and discontinuation of antimetabolite prior to vaccination (OR 9.1,95% CI 1.8–46.5, p = 0.008). T-cell response was demonstrated in 13% (7/53). In conclusion, third dose BNT162b2 improved immune response among KTRs, however 30% still remained seronegative. Pre-vaccination temporary immunosuppression reduction improved antibody response.

Original languageEnglish
Article number10204
JournalTransplant International
StatePublished - 21 Apr 2022


  • COVID-19 vaccine
  • antibody response
  • cellular response
  • immunosuppression reduction
  • kidney transplant recipients


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