Sarinya Boongird’s research while affiliated with Mahidol University and other places

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Publications (36)


P-1997. Real-world Effectiveness of Tixagevimab/cilgavimab for COVID-19 Pre-exposure Prophylaxis in Solid Organ Transplant Recipients during the BA.2.75 and BQ.1 Omicron Variant Period: A matched Case-control Dtudy
  • Article

January 2025

Open Forum Infectious Diseases

Gun Rojanakit

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Sasisopin Kiertiburanakul

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Sarinya Boongird

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[...]

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Background Solid organ transplant recipients (SOTRs) develop poor immunogenicity after SARS-CoV-2 immunization. The neutralizing monoclonal antibody combination of tixagevimab/cilgavimab (T/C) has been shown to reduce the risk of COVID-19 among this vulnerable population. We assessed the effectiveness and safety of T/C pre-exposure prophylaxis (PrEP) for COVID-19 protection after transplantation. Methods We conducted a matched case-control study at a single transplant center during the Omicron lineages BA.2.75 and BQ.1 period (August 2022 to February 2023). T/C doses of 150/150 mg were provided from August 2022 until February 2023, and doses of 300/300 mg were administered thereafter (December 2022 to February 2023). All patients were followed for up to 6 months, and adverse events (AEs) from T/C were assessed. Results A total of 143 SOTRs were included, with 115 and 28 SOTRs in the T/C and control groups, respectively. Transplants included kidney (n=108), liver (n=28), and heart (n=9). Over 6 months, 18 (15.7%) in T/C developed COVID-19, with onset at median 3 months. All had mild infections without respiratory failure. Mild and reversible adverse events (AEs) were reported in 25.2% of cases. No rejection occurred. Non-significantly lower COVID-19 within 3 months during BA.2.75 Omicron (8.7% vs. 17.9% in control; p=0.128; effectiveness: 51.4%). At 6 months (BQ.1 Omicron), COVID-19 incidence was 15.7% in T/C vs. 17.9% in control (p=0.667; effectiveness: 12.3%). The occurrence of COVID-19 was not significantly different after adjustment for the number of vaccine doses, history of prior COVID-19, or the dose of T/C. Conclusion The effectiveness of T/C tends to be protective against susceptible strains, although the severity of breakthrough infections tends to be mild. Short-term safety as PrEP appears tolerable. TCTR20220801004. Disclosures All Authors: No reported disclosures


592. Immunogenicity and Safety of High-dose versus Double-dose Quadrivalent Inactivated Influenza Vaccine in Adult Kidney Transplant Recipients: A Randomized Controlled Trial

January 2025

Open Forum Infectious Diseases

Background Both high-dose and double-dose inactivated influenza vaccines have been shown to better elicit a greater immune response compared to standard-dose influenza vaccine in solid organ transplant (SOT) recipients. However, a direct comparison between high-dose (HD) and double-dose (DD) quadrivalent inactivated influenza vaccine (QIIV) has not been explored. Methods From June to December 2023, we conducted an open-label randomized controlled trial to compare the immunogenicity and safety of the 2023 southern hemisphere HD QIIV at 60 ug (Effluelda, Sanofi) versus double standard-dose QIIV at 30 ug (Fluarix tetra, Sanofi) in adult kidney transplant (KT) recipients. Pre-immunization and 4-week post-immunization sera underwent strain-specific hemagglutination inhibition assays, and safety profiles were assessed. Results Eighty-four eligible KT recipients were randomly assigned to receive either HD QIIV or DD QIIV (42 each). Among them, 50 (59.5%) were male, with a mean age (SD) of 46 (11) years old, and 50 (60.7%) participants received kidneys from deceased donors. Common immunosuppressive regimens included mycophenolate mofetil (65.5%), tacrolimus (77.1%), and prednisolone (100%). SC to at least 1 strain was significantly greater in the HD QIIV group (95.2%) compared to the DD QIIV group (69%) (P = 0.006). The SC rate for A/H1N1, A/H3N2, B/Victoria, and B/Yamagata strains was higher in the HD QIIV group compared to the DD QIIV group, with the following percentages: 69.1% vs 52.4%, 52.4% vs 38.1%, 52.4% vs 42.9%, and 61.9% vs 40.5% (P = 0.118, P = 0.188, P = 0.382, and P = 0.049, respectively). In multivariate analysis, SC to at least 1 vaccine strain was significantly associated with the use of HD vaccine (OR 17.59, 95% CI [2.10, 147.22], P=0.008) and receiving the vaccine after 1-year post-KT (OR 34.76; 95% CI [2.59–454.45], P=0.007). There were significantly fewer occurrences of pain at the injection site and muscle ache in the HD QIIV group compared to the DD QIIV group, with the following percentages: 4.8% vs 19.0%, and 0% vs 9.5% (P = 0.040 and P = 0.043, respectively). Conclusion HD QIIV could marginally elicit a more pronounced immune response, alongside a comparatively reduced occurrence of adverse reactions, in adult SOT recipients when compared with DD QIIV. TCTR20230510005. Disclosures All Authors: No reported disclosures


P-2311. Logical Versus Absolute Lymphocyte Count-guided Preemptive Therapy for CMV Prevention in Solid Organ Transplant Recipients: A Randomized Controlled Trial

January 2025

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1 Read

Open Forum Infectious Diseases

Background A preemptive approach using plasma CMV DNA load monitoring is recommended among CMV-seropositive (R+) solid organ transplant recipients (SOTr). Lately, absolute lymphocyte count (ALC) has been proposed as a surrogate marker to predict CMV infection in SOTr. We hypothesized that a preemptive approach guided by immune assessment, using low ALC, could effectively prevent CMV infection, akin to the proposed routine preemptive therapy. We aimed to assess the efficacy of logical preemptive therapy (LOG) versus ALC-guided preemptive therapy for CMV infection in CMVR+ SOTr, along with cost-effectiveness. Methods A 1:1 open-labeled randomized controlled trial was conducted at a single transplant center from February to November 2023. All adult CMVR+ SOTr not receiving anti-thymocyte globulin were randomly assigned to two groups: the LOG Group, where patients underwent plasma CMV DNA load testing every 4 weeks for 12 weeks after transplantation, and the ALC group, where the quantity of CMV DNA load was initiated when the ALC was < 1,000 cells/mm3. Patients were then followed for 6 months after SOT to compare the occurrence of CMV infection and the CMV DNA load testing-related cost. Results A total of 98 eligible SOTr were included and assigned into two groups, 49 patients each. They all underwent kidney transplantation (KT) with a mean+SD age of 46+11 years old; 66.3% were male. Demographic data between the two groups were comparable. Twenty-five (25.5%) participants developed CMV infection within 6 months after KT. CMV infection was comparably observed in 13 (26.5%) participants in the LOG group vs. 12 (24.5%) participants in the ALC group, p=0.82. Of those, there were no significant differences in terms of asymptomatic CMV infection, CMV disease, and clinically significant CMV infection (p=NS, all). The total cost of plasma CMV DNA load testing (68 USD per test) was significantly lower in the ALC group compared to the LOG group (2,320 vs.10,014 USD, p< 0.01), respectively. Conclusion Immune-guided preemptive therapy directed by low ALC appears to be effective in preventing early CMV infection after SOT. A simple and universally available ALC test could potentially be used as a personalized and cost-effective marker to initiate preemptive therapy in moderate-risk CMVR+ SOTr. TCTR20220720007. Disclosures All Authors: No reported disclosures


Study flowchart.
Event-free probability curves for composite major adverse kidney events over time in SGLT2i and RAAS blockade users.
Event-free probability curves over time for individual components of the composite major adverse kidney events in SGLT2i and RAAS blockade users: (a) decline in eGFR ≥ 40%; (b) eGFR < 15 ml/min/1.73m²; (c) kidney replacement therapy initiation; and (d) death from kidney or cardiovascular causes.
Real-world effectiveness and safety of sodium-glucose co-transporter 2 inhibitors in chronic kidney disease
  • Article
  • Full-text available

January 2025

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17 Reads

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have shown efficacy in clinical trials for slowing chronic kidney disease (CKD) progression, but real-world data in diverse populations are limited. This retrospective study evaluated the effectiveness and safety of SGLT2i versus renin-angiotensin-aldosterone system (RAAS) blockade in CKD patients. Data from Ramathibodi Hospital (2010–2022) were analyzed, including 6,946 adults with CKD stages 2–4, with and without diabetes, who received SGLT2i (n = 1,405) or RAAS blockade (n = 5,541) for at least three months. Patients were matched 1:4 by CKD stage and treatment initiation date. A weighted Cox proportional hazards model with inverse probability weighting assessed the effect on composite major adverse kidney events (MAKEs), including eGFR decline ≥ 40%, progression to CKD stage 5, dialysis initiation, and cardiovascular or kidney death. SGLT2i therapy was associated with a lower risk of composite MAKEs (HR: 0.59; 95% CI: 0.36–0.98; P = 0.041) and less frequent progression to CKD stage 5 (HR: 0.52; 95% CI: 0.34–0.80; P < 0.003). Adverse event rates were similar between groups, with lower urinary tract infection incidence in the SGLT2i group. These findings suggest SGLT2i therapy might reduce adverse kidney outcomes in CKD patients, regardless of diabetic status, with a favorable safety profile. Supplementary Information The online version contains supplementary material available at 10.1038/s41598-025-86172-y.

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Flow of patient inclusion
Multistate model of chronic kidney disease progression. The numbers in each box represent the number of patients within and remaining in each state; the numbers under each transition state represent the number of patients moving between states
Cumulative failure probability for each transition between states
Effects of sodium-glucose cotransporter-2 inhibitors on chronic kidney disease progression: a multi-state survival model

November 2024

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29 Reads

Diabetology & Metabolic Syndrome

Background Current guidelines recommend good glycemic control in patients with type 2 diabetes (T2D) to limit the progression of associated complications with combination therapies. This study aimed to compare the rate of chronic kidney disease (CKD) progression between patients who did or did not receive sodium-glucose cotransporter-2 inhibitors (SGLT2i) using a multistate model with two intermediate states (i.e., CKD stage 4 (CKD4) and 5 (CKD5)) and one absorbing state (i.e., death). Methods Data from patients with T2D and CKD stage 3 (CKD3) were retrieved for analysis. Patients treated with SGLT2i were matched 1:2 by prescription date with non-SGLT2i patients. The multistate model was constructed from Cox survival regression models specific to each transition stage. Cumulative failure and transition probabilities were estimated from bootstrapping. Results Data from 6582 patients (2194 and 4388 patients in the SGLT2i and non-SGLT2i groups, respectively) were analyzed. At 10-year follow-up, patients in the SGLT2i group were more likely to remain at CKD3 compared to the non-SGLT2i group: 82.3% (95% CI 79.9%, 84.6%) vs 60.4% (57.6%, 63.4%). Transition probabilities to CKD4, CKD5, and death were lower in the SGLT2i group than non-SGLT2i group: 11.3% (9.5%, 13.3%) vs 19.8% (17.4%, 22.2%), 2.4% (1.5%, 3.4%) vs 7.4% (5.8%, 9.0%), and 4.1% (2.9%, 5.3%) vs 12.4% (10.3%, 14.6%), respectively. Conclusion SGLT2i may delay the decline in renal function and slow CKD progression compared to standard care without SGLT2i.


Tixagevimab–cilgavimab for preventing breakthrough COVID-19 in dialysis patients: a prospective study

October 2024

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10 Reads

CKJ: Clinical Kidney Journal

Background The effectiveness of tixagevimab–cilgavimab as pre-exposure prophylaxis (PrEP) against breakthrough coronavirus disease 2019 (COVID-19) in dialysis patients remains uncertain due to limited data. Methods In this multicenter prospective study, we enrolled vaccinated dialysis patients and divided them into two groups: tixagevimab–cilgavimab group (received a 150 mg/150 mg intramuscular dose of tixagevimab–cilgavimab) and control group (age-matched patients not receiving tixagevimab–cilgavimab). The primary outcome was the breakthrough COVID-19 rate at six months, whereas secondary outcomes included COVID-19-related hospitalization, ICU admission, endotracheal intubation, and mortality. The safety of tixagevimab–cilgavimab was assessed. Results Two hundred participants were enrolled, with equal numbers in each group (n = 100 each). Baseline characteristics were comparable between groups, except for a higher number of COVID-19 vaccine doses in the tixagevimab–cilgavimab group (median [IQR]: 4 [3–5] vs. 3 [3, 4]; P = 0.01). At six months, the breakthrough COVID-19 rates were comparable between the tixagevimab–cilgavimab (17%) and control (15%) groups (P = 0.66). However, the median (IQR) time to diagnosis of breakthrough infections tended to be longer in the tixagevimab–cilgavimab group (4.49 [2.81–4.98] vs. 1.96 [1.65–2.91] months; P = 0.08). Tixagevimab–cilgavimab significantly reduced COVID-19-related hospitalization rates (5.9% vs. 40.0%; P = 0.02) among participants with breakthrough infections. All tixagevimab–cilgavimab-related adverse events were mild. Conclusion The use of tixagevimab–cilgavimab as PrEP in vaccinated dialysis patients during the Omicron surge did not prevent breakthrough infections but significantly reduced COVID-19-related hospitalizations. Further research should prioritize alternative strategies.




#1277 Comparing advanced glycation end products removal in super high-flux hemodialysis versus high-volume hemodiafiltration: a randomized, crossover study

May 2024

Nephrology Dialysis Transplantation

Background and Aims Expanded hemodialysis using super high-flux membrane, is a promising therapy for effectively clearing middle molecule uremic toxins. However, its impact on advanced glycation end products (AGEs), which is related to an increase in cardiovascular mortality [1], remains inconclusive. Previous studies demonstrated that AGEs increased over time in patients treated with high-flux hemodialysis (HD) [2, 3] while remaining stabilized in online hemodiafiltration (ol-HDF) [3]. This study aims to compare the longitudinal tissue AGEs measured by skin autofluorescence (SAF) between super high-flux hemodialysis (SHF-HD) and high-volume post-dilution ol-HDF. Method In this open-label prospective cross-over 24-week trial, twenty-two prevalent HD patients were randomly assigned to undergone two sequences of 24-week treatment periods: SHF-HD followed by high-volume postdilution ol-HDF or vice versa, with a 4-week wash-out period with high-flux HD between. SAF was measured at baseline and 24 weeks. Midweek pre-HD measurements of beta-2 microglobulin (B2M), serum albumin, normalized protein catabolic rate (NPCR) and Kt/V were obtained every 8 weeks. The amount of dialysate albumin was collected by continuous sampling of spent dialysate method and determined by immunoturbidimetric assay Results Seventeen out of twenty-two patients completed the study. At baseline, SAF levels (3.88 ± 0.14 vs 3.99 ± 0.14 AU, p = 0.463) and pre-HD B2M (22.66 ± 1.41 vs 21.09 ± 1.41 mg/L, p = 0.228) were similar between the SHF-HD and ol-HDF groups. After 24 weeks, SAF levels showed no significant change in SHF-HD (from 3.88 ± 0.14 to 3.91 ± 0.14 AU, p = 0.846) and ol-HDF (from 3.99 ± 0.14 to 3.95 ± 0.14 AU, p = 0.796), with a mean difference of change 0.06 (95% CI −0.34, 0.47, p = 0.75). Similarly, mid-week pre-HD serum B2M at 24 weeks exhibited no significant change in the SHF-HD group (22.66 ± 1.41 to 22.18 ± 1.47 mg/L, p = 0.722) and the ol-HDF group (21.09 ± 1.41 to 21.83 ± 1.45 mg/L, p = 0.577), with a mean difference of change −1.22 (95% CI −4.94, 2.49, p = 0.519). The spKt/V urea did not exhibit any notable differences. Furthermore, pre-HD levels of all small uremic toxins after the 24-week periods did not differ between both groups. Nutritional status measured by serum albumin and NPCR were comparable despite higher dialysate albumin loss in postdilution ol-HDF group (0.82 ± 0.04 vs 1.92 ± 0.12 g, p < 0.001 in SHF-HD and ol-HDF, respectively) Conclusion After 24 weeks of treatment, SHF-HD demonstrated levels of AGEs, pre-HD serum B2M, and serum albumin comparable to high-volume ol-HDF. If high-volume postdilution ol-HDF is not feasible, SHF-HD may serve as a valuable alternative treatment for stabilizing AGEs in chronic hemodialysis patients.


494. Real-world effectiveness of tixagevimab/cilgavimab for COVID-19 pre-exposure prophylaxis in solid organ transplant recipients during the Omicron variant period

November 2023

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15 Reads

Open Forum Infectious Diseases

Background Pre-exposure prophylaxis (PrEP) with a combination of long-acting monoclonal antibodies with tixagevimab/cilgavimab (T/C) have provided viral neutralizing activity against SARS-CoV-2 and protected solid organ transplant recipients (SOTRs) that produced poor immunogenicity after COVID-19 immunization. However, real-world data on the effectiveness and safety of T/C in SOTRs during the Omicron wave is limited. Methods A prospective study at a single transplant center was conducted to evaluate the effectiveness and adverse events (AE) of T/C among SOTRs during the BA.2.75 Omicron lineages period (August 2022 to February 2023). T/C of 150/150 and 300/300 mg doses were provided from August 2022 to December 2022 and after, respectively. Results A total of 39 SOTRs comprising kidney (n= 29), liver (n=2), and heart (n=8) transplant recipients were included in the study. Thirty-three (85%) and 6 (15%) SOTRs received 150/150 and 300/300 mg of T/C, respectively. The median (IQR) age was 52 (35-62) years. Twenty-two (56%) had a prior history of COVID-19. The median (IQR) number of COVID-19 vaccine was 4 (3-4) doses. During the median follow-up of 6.35 (5-8.33) months, COVID-19 developed in 5 (12.8%) out of 39 SOTRs with a median (IQR) time of 73 (36-115) days from receiving T/C. None of those who received a 300/300 mg dose developed COVID-19. There was no severe COVID-19 or death observed. Five (12.8%) SOTRs reported mild and reversible AEs with pain at injection (n=2), fever (n=3), and muscle aches (n=1). There was no allograft rejection reported. Conclusion Breakthrough SARS-CoV-2 infection remains among fully vaccinated SOTRs receiving T/C as PrEP and subjects to concurrent circulating strain in the community. However, the disease severity appears mild, and the short-term safety profile seems tolerable. Disclosures All Authors: No reported disclosures


Citations (21)


... These life tables are typically derived from each country's demographic and health data, reflecting the actual life expectancy and health conditions of the local population. The advantage of this method is that the results [30][31][32][33], while nine studies used aspirational life tables, representing the ideal standard [34][35][36]. Kassymbekova et al. (2024) [37] also noted that the YLL calculations based on life expectancy from the GBD study, which is significantly higher than that of Kazakhstan, might lead to an overestimation of YLL, DALYs, and the proportion of YLL to YLD. ...

Reference:

Disability‐Adjusted Life Years (DALYs) due to Breast, Cervical, Colorectal and Oral Cancers in Taiwan Regions
Year of Life Lost due to Premature Death from Glomerulonephritis in Thailand: PO1568
  • Citing Article
  • October 2021

Journal of the American Society of Nephrology

... In another study, individuals with peritoneal dialysis who were diagnosed with COVID-19 between August 2021 and July 2022 had a hospitalization rate of 62%; almost two thirds of those hospitalized required oxygen or other invasive respiratory support [89]. In an Italian study, COVID-19 hospitalization among patients with kidney transplant was 27% higher prior to vaccination, but lower among individuals with three doses of a COVID-19 vaccine (8%) [67]. ...

Fatality rate, risk factors, and functional decline in peritoneal dialysis patients with coronavirus disease 2019: A nationwide cohort study

... For instance, CKD patients present 8 to 25 times higher increased risk of developing active TB compared to general population (6, 10). Also, mortality rates associated with TB are even higher, especially among those on renal replacement therapy (RRT) (11,12). The uremic state in CKD, characterized by the retention of toxins, disrupts the immune system and results in a decrease of B7-2 co-stimulatory molecule expression in antigen-presenting cells, interfering with the function of polymorphonuclear cells and monocytes/macrophages by altering their phagocytic capacity, low e ciency of chemotactic migration and a decrease in cellular response in the control of intracellular microorganisms (13,14). ...

Interferon-gamma release assays for diagnosis of latent TB infection in chronic kidney diseases and dialysis patients

... We identified six studies: one conducted in Australia, 33 one conducted in Thailand, 34 one conducted in Brazil 35 and three conducted in the USA. [36][37][38] Five studies were cross-sectional, and one was longitudinal. ...

The hidden financial catastrophe of chronic kidney disease under universal coverage and Thai “Peritoneal Dialysis First Policy”

... The evidence on heterologous vaccinations has been conflicting. Two studies showed no statistically significant difference in immunogenicity when comparing homologous vaccination with heterologous vaccination, while another study demonstrated that employing heterologous viral vector vaccine as booster was associated with lower antibody titres when compared to homologous mRNA vaccine [47][48][49]. Pre-exposure prophylaxis using a long-acting monoclonal antibodies combination (tixagevimab and cilgavimab) can be considered in KTRs [50], but its use is often limited by drug availability and should not be regarded as a substitute for effective immunization. Other useful strategies include ring vaccination of household members and close contacts in KTRs, especially for those with suboptimal immune response to vaccination. ...

An additional dose of viral vector COVID-19 vaccine and mRNA COVID-19 vaccine in kidney transplant recipients: A randomized controlled trial (CVIM 4 study)

American Journal of Transplantation

... The historical placebo-controlled trial of the fID COVID-19 vaccine is unavailable. Therefore, a relatively stable SARS-CoV-2-specific immunity level was assumed for the placebo arm since vaccine-induced immunity levels would plateau 3-6 months following the third COVID-19 vaccine, [23,24] coinciding with the time between enrolment and primary outcome measurement in this study. The effect size of the placebo was deduced from the possible variations in the serological surrogate values (i.e., the within-laboratory measurement variability of the laboratory tests), which are 4.2-6.4% for SARS-CoV-2 IgG II SEMI QUANT assay and 2.3-7.5% for Quan-T-Cell SARS-CoV-2 according to the assays' manuals. ...

Durability of Humoral and Cellular Immunity after an Extended Primary Series with Heterologous Inactivated SARS-CoV-2 Prime-Boost and ChAdOx1 nCoV-19 in Dialysis Patients (ICON3)

... Immunization against SARS-CoV-2 is essential and proven to avoid complications and unfavorable consequences [6,7]. However, suboptimal immunogenicity, especially humoral immunity (HMI), is concerning among these specific individuals [8,9]. Although cell-mediated immunity was believed to play an essential role in preventing the progression of the disease, it has been reported to vary among different vaccine platforms [10][11][12][13][14]. ...

Immunogenicity of ChAdOx1 nCoV-19 vaccine after a two-dose inactivated SARS-CoV-2 vaccination of dialysis patients and kidney transplant recipients

... Nevertheless, data are scarce when it comes to the inactivated virus vaccines. Only a handful of articles demonstrated 50-88% rates of antibody production against the receptor-binding domain of SARS-CoV-2 1 month after two doses without any longitudinal follow-up [9][10][11]. A study investigated the durable humoral responses for 6 months, yet there was no comparison with an mRNA-based vaccine [12]. ...

Short-Term Immunogenicity Profiles and Predictors for Suboptimal Immune Responses in Patients with End-Stage Kidney Disease Immunized with Inactivated SARS-CoV-2 Vaccine

Infectious Diseases and Therapy

... In another study, kidney transplant recipients were vaccinated with the inactivated Sinopharm-CoronaVac (BBIBP-CorV) vaccine; results showed that only 9% of transplant recipients had adequate antibody levels, while antibody levels in 100% of participants in the control group were acceptable [22]. Differences in the type of vaccine platform, the number of participants, and factors affecting seroconversion in transplant recipients, such as the type of immunosuppressive regimens, time elapsed after transplantation, and underlying diseases, can influence seroconversion rates in different vaccine types. ...

SARS‐CoV‐2‐specific Humoral and Cell‐mediated Immune Responses after Immunization with Inactivated COVID‐19 Vaccine in Kidney Transplant Recipients (CVIM 1 Study)

American Journal of Transplantation

... Several other studies that included a mix of both hemodialysis and peritoneal dialysis patients found conflicting results. Most studies found no difference between dialysis modalities [20][21][22][23][24] while one found better results in hemodialysis [24] and another a better response rate in peritoneal dialysis [25]. The small number of patients in those studies may explain the discordant results. ...

Anti-SARS-CoV-2 Spike Protein S1 Receptor-Binding Domain Antibody to An Inactivated Whole-virus SARS-CoV-2 Vaccination in End-stage Kidney Disease Patients: An Initial Report

Kidney International