Research results highlight the importance of a personalised approach to vaccination for kidney transplant patients
A study published today in the Lancet has revealed that blood tests can predict the severity of Covid-19 infection in kidney transplant patients and could lead to individualised approaches to vaccination.
The MELODY study, led by Dr Michelle Willicombe from Imperial College London, was supported by a collaboration of research charities and medical funders led by Kidney Research UK to ensure better representation of at-risk groups in pandemic research. MELODY is the largest study to date in people with rare diseases and solid organ transplants with 28,411 participants, including 6,591 who had received a kidney transplant.
About the MELODY study
MELODY (Mass Evaluation of Lateral Flow Immunoassays for the Detection of SARS-CoV-2 Antibody in Immunosuppressed People Study) researchers investigated 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. Individuals receiving medications that reduce the efficacy of their immune system (known as ‘immunosuppressants’) for certain conditions, including after transplantation, were eligible to join the study.
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. With consent from all participants, researchers examined participants’ NHS health records to assess the impact of vaccine response on health outcomes, such as hospitalisation.
The research was undertaken in collaboration with NHS Blood and Transplant.
Data shows vaccinations reduce chance of infection and risk of needing hospital treatment in at-risk patients
Antibodies to Covid-19 were found in 76% of kidney transplant patients, with health records showing a reduced number of infections and hospital admission following infection in this group compared to those without antibodies.
Michelle said: “Although it is really reassuring to see that most patients in this group responded well to vaccination, we know this approach can be less effective in patients treated with immunosuppressive medication than in the general population and careful consideration in any protective strategies is required.
"MELODY has shown it is possible to individually assess vaccine response and the risk of severe outcomes following Covid-19 infection in this group. This information has the potential to support personalised approaches to Covid-19 prevention, such as individualised vaccination schedules or treatments, helping at-risk patients to benefit more equally from available public health measures.”
Important implications for kidney disease patients
Other factors found to be related to higher rates of infection across all participants groups included on-going shielding and living in a household with children. The study authors suggest that the risk in those who shield may be related to being infected with Covid-19 for the first time as shielding levels decreased. Further emphasing the importance of considering individual circumstances, higher infection levels in families with children may reflect the difficulties of preventing disease spread within households.
Michelle commented: “Vaccination has improved the outcomes of Covid-19 infection considerably for most patients, but we know that we will face outbreaks of viruses in the future. MELODY has provided valuable information on how best to protect at-risk populations both in terms of behavioural changes such as shielding, and vaccinating, based on personal circumstances. This knowledge can be applied to inform ongoing Covid-19 risk and also outbreaks of other viruses, should they occur.”
Dr Aisling McMahon, Executive director of research at Kidney Research UK commented “This hugely important work has shown that Covid-19 vaccination has protected many kidney transplant recipients from Covid-19. It also demonstrates that we can identify those who remain at-risk simply and reliably. We must now build on these findings to ensure that planning for future vaccinations strategies is informed by these results and supports the best outcomes for at-risk individuals. I would like to thank all the patients who participated in this groundbreaking study and to congratulate everyone involved in MELODY.”
Funders: Kidney Research UK, UK Research and Innovation, Blood Cancer UK, Vasculitis UK and the Cystic Fibrosis Trust
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