Table 3.
Characteristics of ten chronic hemodialysis patients with 4–5 repeat vaccinations after non-response to 3 standard SARS-CoV-2 vaccine doses.
| No. | Age | BMI | Diabetes | pKTx | Vintage | Vaccination | isMeds | aTumor | Albumin | Kt/V | IgG | nTiter |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1. | 50–55 | 23.0 | / | Yes | 1.59 | 5 times mRNA | ldST/Tacrolimus | / | 2843 | 1.1 | >433 | 87 |
| 2. | 85–90 | 32.4 | / | / | 0.93 | 4 times mRNA | ldST | Yes | 3116 | 1.1 | 0 | 5 |
| 3. | 65–70 | 27.7 | / | / | 3.70 | 4 times mRNA | / | / | 3624 | 1.4 | >433 | 94 |
| 4. | 95–100 | 30.6 | / | / | 1.77 | 1 vector + 3 mRNA | ldST | / | 3526 | 0.8 | 211 | 88 |
| 5. | 60–65 | 31.3 | / | / | 1.11 | 4 times mRNA | ST/Cyclophosphamide | / | 3481 | 1.1 | >433 | 98 |
| 6. | 85–90 | 25.7 | / | / | 2.38 | 4 times mRNA | / | / | 3829 | 0.9 | >433 | 100 |
| 7. | 80–85 | 23.7 | Yes | / | 5.82 | 4 times mRNA | / | / | 3069 | 1.0 | >433 | 100 |
| 8. | 75–80 | 23.8 | / | / | 6.12 | 4 times mRNA | ST/Daratumumab | Yes | 3450 | 1.3 | >433 | 99 |
| 9. | 80–85 | 20.0 | Yes | / | 5.91 | 4 times mRNA | / | / | 3330 | 1.4 | >433 | 58 |
| 10. | 90–95 | 22.2 | / | / | 2.69 | 4 times mRNA | ldST | / | 3333 | 0.9 | >433 | 83 |
Age in years, BMI = body mass index in kg/m2, pKTx = prior kidney transplant, vintage = time on dialysis in years, isMeds = presence of immunosuppressive medication, ST = steroids, ldST = low-dose steroids, aTumor = active malignancy, IgG = SARS-CoV-2 IgG antibody titers in BAU/mL, nTiter = neutralizing titer (capacity) of IgG antibodies in %. Laboratory evaluation was performed an average 87 ± 40 days after the last vaccination. Patient number 1. responded to repeat vaccination after transplant nephrectomy and discontinuation of tacrolimus, patient number 2. suffered from smoldering prostate cancer, and patient number 4. did not mount adequate antibody levels after repeat vaccination presumably due to immunosenescence and longtime steroid medication, whereas all other patients were able to mount protective levels of SARS-CoV-2 antibodies after four vaccinations. Of note, even patients on prior immunosuppressive medication mounted protective antibody titers after cessation of the respective drugs (tacrolimus was stopped after transplant nephrectomy, cyclophosphamide was stopped after renal failure due to systemic vasculitis, and daratumumab was reduced by increasing application intervals). Multiple vaccine administrations also resulted in no measurable side effects or safety concerns, 60% of pts were male.