TY - JOUR AU - Schrezenmeier, Eva AU - Rincon-Arevalo, Hector AU - Jens, Annika AU - Stefanski, Ana-Luisa AU - Hammett, Charlotte AU - Osmanodja, Bilgin AU - Koch, Nadine AU - Zukunft, Bianca AU - Beck, Julia AU - Oellerich, Michael AU - Proß, Vanessa AU - Stahl, Carolin AU - Choi, Mira AU - Bachmann, Friederike AU - Liefeldt, Lutz AU - Glander, Petra AU - Schütz, Ekkehard AU - Bornemann-Kolatzki, Kirsten AU - López del Moral, Covadonga AU - Schrezenmeier, Hubert AU - Ludwig, Carolin AU - Jahrsdörfer, Bernd AU - Eckardt, Kai-Uwe AU - Lachmann, Nils AU - Kotsch, Katja AU - Dörner, Thomas AU - Halleck, Fabian AU - Sattler, Arne AU - Budde, Klemens T1 - Temporary antimetabolite treatment hold boosts SARS-CoV-2 vaccination–specific humoral and cellular immunity in kidney transplant recipients PY - 2022/05/09/ AB - Transplant recipients exhibit an impaired protective immunity after SARS-CoV-2 vaccination, potentially caused by mycophenolate (MPA) immunosuppression. Recent data from patients with autoimmune disorders suggest that temporary MPA hold might greatly improve booster vaccination outcomes. We applied a fourth dose of SARS-CoV-2 vaccine to 29 kidney transplant recipients during a temporary (5 weeks) MPA/azathioprine hold, who had not mounted a humoral immune response to previous vaccinations. Seroconversion until day 32 after vaccination was observed in 76% of patients, associated with acquisition of virus-neutralizing capacity. Interestingly, 21/25 (84%) calcineurin inhibitor–treated patients responded, but only 1/4 belatacept-treated patients responded. In line with humoral responses, counts and relative frequencies of spike receptor binding domain–specific (RBD-specific) B cells were markedly increased on day 7 after vaccination, with an increase in RBD-specific CD27++CD38+ plasmablasts. Whereas overall proportions of spike-reactive CD4+ T cells remained unaltered after the fourth dose, frequencies were positively correlated with specific IgG levels. Importantly, antigen-specific proliferating Ki67+ and in vivo–activated programmed cell death 1–positive T cells significantly increased after revaccination during MPA hold, whereas cytokine production and memory differentiation remained unaffected. In summary, antimetabolite hold augmented all arms of immunity during booster vaccination. These data suggest further studies of antimetabolite hold in kidney transplant recipients. JF - JCI Insight JA - JCI Insight SN - 2379-3708 DO - 10.1172/jci.insight.157836 VL - 7 IS - 9 UR - https://doi.org/10.1172/jci.insight.157836 PB - The American Society for Clinical Investigation ER -