Basuli D, Ross B, Rebellato LM. Clinical predictors of SARS-CoV-2 vaccine immunogenicity in kidney transplant recipients at a rural center. World J Transplant 2026; 16(2): 119075 [DOI: 10.5500/wjt.v16.i2.119075]
Corresponding Author of This Article
Debargha Basuli, MD, PhD, Assistant Professor, Department of Nephrology and Hypertension, Brody School of Medicine, East Carolina University, 2355 W Arlington Blvd, Greenville, NC 27834, United States. basulid17@ecu.edu
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Transplantation
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research-article
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Basuli D, Ross B, Rebellato LM. Clinical predictors of SARS-CoV-2 vaccine immunogenicity in kidney transplant recipients at a rural center. World J Transplant 2026; 16(2): 119075 [DOI: 10.5500/wjt.v16.i2.119075]
World J Transplant. Jun 18, 2026; 16(2): 119075 Published online Jun 18, 2026. doi: 10.5500/wjt.v16.i2.119075
Clinical predictors of SARS-CoV-2 vaccine immunogenicity in kidney transplant recipients at a rural center
Debargha Basuli, Bonnie Ross, Lorita M Rebellato
Debargha Basuli, Department of Nephrology and Hypertension, Brody School of Medicine, East Carolina University, Greenville, NC 27834, United States
Bonnie Ross, Lorita M Rebellato, Department of Pathology and Laboratory Medicine, Brody School of Medicine, East Carolina University, Greenville, NC 27834, United States
Author contributions: Basuli D conceived and designed the study, performed data analysis, and drafted the manuscript; Ross B and Rebellato LM contributed to data acquisition, interpretation of results, and critical revision of the manuscript; all authors reviewed and approved the final version of the manuscript.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of East Carolina University. The requirement for informed consent was waived due to the retrospective nature of the study and use of de-identified data.
Informed consent statement: Informed consent was waived by the Institutional Review Board due to the retrospective study design and use of de-identified data.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest related to this study.
STROBE statement: The authors have read the STROBE Statement checklist for observational studies and confirm that the manuscript was prepared and revised in accordance with STROBE guidelines.
Data sharing statement: The data supporting the findings of this study are available from the corresponding author upon reasonable request.
Corresponding author: Debargha Basuli, MD, PhD, Assistant Professor, Department of Nephrology and Hypertension, Brody School of Medicine, East Carolina University, 2355 W Arlington Blvd, Greenville, NC 27834, United States. basulid17@ecu.edu
Received: January 21, 2026 Revised: February 3, 2026 Accepted: March 18, 2026 Published online: June 18, 2026 Processing time: 131 Days and 8.8 Hours
Abstract
BACKGROUND
Kidney transplant recipients (KTR) have impaired immune responses to vaccination and remain at increased risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection despite mRNA coronavirus disease 2019 (COVID-19) vaccination. Data from rural and medically underserved transplant populations remain limited.
AIM
To evaluate serologic response to a two dose mRNA SARS-CoV-2 vaccination series and identify clinical factors associated with antibody response in KTR.
METHODS
This single center retrospective observational study included adult KTR who completed a two dose mRNA COVID-19 vaccination series and had post vaccination anti spike IgG testing performed using stored serum samples. Multivariable logistic regression was used to identify predictors of seroconversion. Among responders, linear regression was used to evaluate factors associated with quantitative antibody titers.
RESULTS
A total of 108 KTR were included, of whom 63 (58.3%) achieved seroconversion. Higher estimated glomerular filtration rate showed independent association with seroconversion, while higher mycophenolic acid dose showed inverse association with response. Black race and basiliximab induction demonstrated association with seroconversion, though estimates were imprecise. Age, sex, body mass index, vaccine type, tacrolimus levels, and comorbidities were not independently associated with response. Among responders, no clinical or demographic variables were significantly associated with antibody titers.
CONCLUSION
After two dose mRNA vaccination, fewer than two thirds of KTR developed detectable anti spike antibodies. Serologic response was associated with allograft function and antimetabolite exposure, while antibody magnitude was not explained by routine clinical factors in this cohort. These findings provide real world data from a rural transplant population and support consideration of augmented vaccination strategies in KTR.
Core Tip: In a rural kidney transplant population, fewer than two thirds of recipients developed detectable antibodies after a standard two dose mRNA severe acute respiratory syndrome coronavirus 2 vaccination series. Serologic response was associated with allograft function and antimetabolite exposure, while routine demographic and clinical factors did not predict antibody magnitude among responders. Because immune assessment was limited to a binding antibody assay and clinical outcomes were not evaluated, these findings describe serologic response rather than clinical protection and should be interpreted accordingly.
