Background: While several studies have observed that solid organ transplant recipients experience diminished antibody responses to SARS-CoV-2 mRNA vaccination, data specific to heart and lung transplant (HT/LT) recipients remains sparse. Methods: US adult HT and LT recipients completed their vaccine series between January 7 and April 10, 2021. Reactogencity and SARS-CoV-2 anti-spike antibody were assessed after a priming dose (D1) and booster dose (D2). Modified Poisson regression with robust variance estimator was used to evaluate associations between participant characteristics and antibody development. Results: Of 134 heart recipients, there were 38% non-responders (D1-/D2-), 48% booster responders (D1-/D2+), and 14% priming dose responders (D1+/D2+). Of 103 lung recipients, 64% were non-responders, 27% were booster responders, and 9% were priming dose responders. Lung recipients were less likely to develop antibodies (p<0.001). Priming dose antibody response was associated with younger recipient age (p=0.04), transplant-to-vaccination time ≥ 6 years (p<0.01), and lack of anti-metabolite maintenance immunosuppression (p<0.001). Pain at injection site was the most commonly reported reaction (85% after D1, 76% after D2). Serious reactions were rare, the most common being fatigue (2% after D1 and 3% after D2). No serious adverse events were reported. Conclusions: HT and LT recipients experienced diminished antibody response following vaccination; reactogenicity was comparable to that of the general population. LT recipients may exhibit a more impaired antibody response than HT recipients. While current recommendations are to vaccinate eligible candidates and recipients, further studies characterizing the cell-mediated immune response and clinical efficacy of these vaccines in this population are needed.
Prior studies have demonstrated a decreased humoral response in solid organ transplant recipients (SOTRs) to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) messenger RNA (mRNA) vaccination (17% antibody response after dose 1 [D1], 54% after dose 2 [D2]) compared with the general population (100%).However, these studies were dominated by kidney transplant recipients and included only a small percentage of liver transplantation (LT) recipients (19.6%). (1)(2)(3)(4) Because LT recipients often receive milder induction and maintenance immunosuppression, they may have a more robust humoral response. To investigate this, we studied SARS-CoV-2 antibody development in a cohort of LT recipients who completed a 2-dose mRNA vaccine series of either mRNA-1273 (Moderna, Cambridge, MA) or BNT162b2 (Pfizer-BioNTech, New York, NY). Patients and MethodsInclusion criteria were post-LT patients with no reported prior positive SARS-CoV-2 polymerase chain reaction result. Participants were excluded if they were younger than 18 years old. Participants were recruited via convenience sampling through social media or transplant center advertisements and if they completed a 2-dose mRNA vaccine course between January 7, 2021, and March 26, 2021 and were followed through April 7, 2021. Data on demographics, body mass index (BMI), prior COVID-19 diagnosis, hospitalization, transplant information, medications, other immune conditions, and allergies were collected. The study had institutional review board approval, and informed consent was obtained. The blood sampling protocol used 2 SARS-CoV-2 spike protein immunoassays (EUROIMMUN [Lubek, Germany] to the subunit 1 [S1] domain and Roche Elecsys [Indianapolis, IN] to the receptor binding domain [RBD] of the SARS-CoV-2 spike protein) and has been described elsewhere. (1) We have shown in prior work that the distribution of vaccine responses did not differ when using the anti-S1 or anti-RBD assay. (4) The post-D1 assay was performed as close to D2 as possible, and the post-D2 assay was collected as close to 28 days as possible. Of note, the Roche assay is artificially truncated at >250 U/mL.
We compared the outcome of arthroscopic repair of the rotator cuff in 32 diabetic patients with the outcome in 32 non-diabetic patients matched for age, gender, size of tear and comorbidities. The Constant-Murley score improved from a mean of 49.2 (24 to 80) pre-operatively to 60.8 (34 to 95) post-operatively (p = 0.0006) in the diabetic patients, and from 46.4 (23 to 90) pre-operatively to 65.2 (25 to 100) post-operatively (p = 0.0003) in the non-diabetic patients at six months. This was significantly greater (p = 0.0002) in non-diabetic patients (18.8) than in diabetics (11.6). There was no significant change in the mean mental component of the Short-Form 12, but the mean physical component increased from 35 to 41 in non-diabetics (p = 0.0001), and from 37 to 39 (p = 0.15) in diabetics. These trends were observed at one year. Patients with diabetes showed improvement of pain and function following arthroscopic rotator cuff repair in the short term, but less than their non-diabetic counterparts.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.