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New study shows importance of Covid-19 vaccines in patients who have had a kidney transplant

23 February 2023

The MELODY study, co-funded by Kidney Research UK, involved more than 28,000 immunocompromised patients across the UK, including those with solid organ transplants, patients with blood cancer and autoimmune diseases (including vasculitis and lupus). MELODY is the largest study ever to be performed in people with rare diseases and solid organ transplants.

Crucial new data for kidney disease patients

Results from the MELODY study published on 14 February 2023 revealed that of the 9,927 patients involved who had previously received a solid organ transplant (including 6,591 kidney patients), 77% produced antibodies following Covid-19 vaccinations; with the proportion increasing with each additional vaccine dose. Of the autoimmune diseases group, including patients with kidney disease related to these conditions, 86% responded to Covid-19 vaccination, also increasing with the number of vaccine doses received.

Investigators additionally found that across all patient groups, antibody production was more likely in younger people and those who had previously been infected with Covid-19.  The type and combination of immunosuppressant drugs was also important; antibodies were less likely to be found in transplant recipients receiving three different anti-rejection medications. In the other patient groups, rituximab, a drug commonly used to treat vasculitis and other autoimmune diseases, was shown to be associated with a lack of antibodies.

About the MELODY study

MELODY researchers measured whether patients developed antibodies (proteins that are produced by the body’s immune system to help fight infection) against the virus that causes Covid-19, following a minimum of three vaccinations. 

Study participants, who were recruited between December 2021 and June 2022, used a home-based, self-administered rapid Covid-19 test. Unlike the well-known lateral flow rapid antigen tests which show current infection with the Covid-19 virus, patients provided a droplet of blood from a self-administered thumb or finger prick in order to detect long-lasting antibody protection. 

Researchers also asked participants to complete a questionnaire online, covering demographic information, details of immunosuppressive treatments and behaviour. 

Dr Michelle Willicombe
Dr Michelle Willicombe, Clinical Reader in Renal Pathology and Honorary Consultant Nephrologist at Imperial College Healthcare NHS Trust

Study author and consultant nephrologist Dr Michelle Willicombe commented: These results show the importance of booster vaccines in immunosuppressed people and is consistent with other studies showing improvement in outcomes with vaccinations.  Importantly, they also show that even after five vaccine doses, a minority of patients do not mount an antibody response.  Our subsequent results will show definitive evidence whether such patients are at increased risk of more severe illness with COVID-19 infection, but until then it will be important to ensure all immunosuppressed people have access to treatments, offering a further layer of protection. 

New approaches needed for at-risk patients

Further data showing whether antibody-negative patients experienced serious symptoms following Covid-19 infection are expected from the MELODY study in early summer 2023. This could help the NHS plan how best to manage patients who do not respond well to vaccination during any future Covid-19 waves.  

Michelle noted: “These results highlight how important keeping up-to-date with Covid-19 vaccinations is. We also hope that the next set of results will help healthcare professionals to identify and assist those patients who may remain at risk of serious outcomes from Covid-19 despite vaccination.” 

Dr Aisling McMahon, executive director of research and policy at Kidney Research UK, said: “Covid-19 has presented serious challenges for everyone, but for those who are less able to fight infections due to immunosuppressive medications following a kidney transplant it has been an especially difficult time. Although it is encouraging to see that so many patients in this group respond well to vaccination, we urge the Government to ensure that adequate options are available for those who do not. Kidney Research UK’s investment in the MELODY study reflects our ongoing commitment to ensuring that the kidney disease community is not disadvantaged by public health policy decisions around available treatments.” 

What do these results mean for kidney disease patients?

MELODY confirms the importance of making sure that all kidney disease patients receive their Covid-19 boosters and will help healthcare providers to identify those most at-risk of complications. It also highlights that not all patients will produce antibodies against Covid-19, despite multiple vaccinations.

Further information on which patients may develop serious symptoms following Covid-19 infection will be available later this year. Kidney Research UK is committed to supporting equality in access to Covid-19 prevention and treatment – the work of Michelle and her team is an important part of this.

Find out more

Get further information on Covid-19 and kidney disease on our website and find more information about transplantation. 

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