Pediatric Infectious Diseases “Specialist” in Durham, North Carolina
Daniel Chang, MD, MSCE
Dr. Dan Chang’s claim to fame is his refusal to give a 14-year-old girl a kidney transplant because she has not received the Covid shot despite her already having had Covid.
Assistant Professor of Pediatrics
C19 mRNA vaccines have demonstrated markedly lower efficacy specifically in kidney transplant patients, as reported in the following study:
Germinal Center Responses to SARS-CoV-2 mRNA Vaccines in Healthy and Immuno-compromised Individuals
Summary: Vaccine-mediated immunity often relies on the generation of protective antibodies and memory B cells, which commonly stem from germinal center (GC) reactions. An in-depth comparison of the GC responses elicited by SARS-CoV-2 mRNA vaccines in healthy and immunocompromised individuals has not yet been performed due to the challenge of directly probing human lymph nodes. In this study, through a fine-needle-aspiration-based approach, we profiled the immune responses to SARS-CoV-2 mRNA vaccines in lymph nodes of healthy individuals and kidney transplant (KTX) recipients. We found that, unlike healthy subjects, KTX recipients presented deeply blunted SARS-CoV-2-specific GC B cell responses coupled with severely hindered T follicular helper cells, SARS-CoV-2 receptor-binding-domain-specific memory B cells and neutralizing antibodies. KTX recipients also displayed reduced SARS-CoV-2-specific CD4 and CD8 T cell frequencies. Broadly, these data indicate impaired GC-derived immunity in immunocompromised individuals, and suggest a GC-origin for certain humoral and memory B cell responses following mRNA vaccination… Nonetheless, our study reported for the first time a complete failure of KTX recipients in forming lymphoid tissue SARS-CoV-2-specific GC B cell responses after the administration of two mRNA vaccine doses.
“Overall, our study indicates that KTX recipients poorly respond to two immunizations with SARS- CoV-2 mRNA vaccines by failing to produce efficient humoral and cellular responses, with some immune responses (GC B cells, nAb RBD-specific memory B cells and SARS-CoV-2-specific T cells) that were more severely affected than others (binding Abs, Full S-specific memory B cells). Since an increasing body of evidence is now suggesting that the administration of a third vaccine dose can significantly boost SARS-CoV-2 binding Abs and nAbs in recipients of SOT (solid organ transplants), it will be interesting to assess in the future whether this is due to the expansion of the small pool of preexisting (Full S+RBD-) memory B cells that we identified in this study, or to an increased de novo generation of Abs via GC reactions. Suboptimal vaccine responses in organ transplant subjects receiving immunosuppressant drugs were previously reported for other vaccines including influenza A/H1N1 and Hepatitis B. Collectively, these studies reported impaired Ab production post vaccination, which is reflective of a dysfunction of the immune system in individuals receiving immunosuppressant drugs.”