Cellular and humoral immune response after mRNA-1273 SARS-CoV-2 vaccine in liver and heart transplant recipients

Abstract

Recently published studies have found an impaired immune response after SARS‐CoV‐2 vaccination in solid organ recipients. However, most of these studies have not assessed immune cellular responses in liver and heart transplant recipients. We prospectively studied heart and liver transplant recipients eligible for SARS‐CoV‐2 vaccination. Patients with past history of SARS‐CoV‐2 infection or SARS‐CoV‐2 detectable antibodies (IgM or IgG) were excluded. We assessed IgM/IgG antibodies and ELISpot against the S protein 4 weeks after receiving the second dose of the mRNA‐1273 (Moderna) vaccine. Side effects, troponin I, liver tests and anti‐HLA donor‐specific antibodies (DSA) were also assessed. A total of 58 liver and 46 heart recipients received two doses of mRNA‐1273 vaccine. Median time from transplantation to vaccination was 5.4 years (IQR 0.3–27). Sixty‐four percent of the patients developed SARS‐CoV‐2 IgM/IgG antibodies and 79% S‐ELISpot positivity. Ninety percent of recipients developed either humoral or cellular response (87% in heart recipients and 93% in liver recipients). Factors associated with vaccine unresponsiveness were hypogammaglobulinemia and vaccination during the first year after transplantation. Local and systemic side effects were mild or moderate, and none presented DSA or graft dysfunction after vaccination. Ninety percent of our patients did develop humoral or cellular responses to mRNA‐1273 vaccine. Factors associated with vaccine unresponsiveness were hypogammaglobulinemia and vaccination during the first year after transplantation, highlighting the need to further protect these patients.

Immunological and clinical efficacy of COVID-19 vaccines in immunocompromised populations: a systematic review

“…Thirty studies reported neutralization assay results in addition to anti-SARS-CoV-2 antibody assays [ 34 , 37 , 41 , 48 , 51 , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] ]. Thirty-one studies provided data on cellular immunity [ 17 , 21 , 22 , 34 , 37 , 41 , 45 , 46 , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , 72 , [74] , [75] , [76] , [77] , [79] , [80] , [81] , [82] , [83] , [84] ].…”

“…Forty-seven studies described immunogenicity across various solid organ transplant populations ( n = 5974), mostly in kidney transplant recipients ( n = 3534, 59.2%) ( Table S5 ) [ 18 , [20] , [21] , [22] , [23] , [24] , [25] , [26] , 29 , 34 , 40 , [56] , [57] , [58] ], [ 62 , 63 , 65 , 66 , 69 , 72 , 73 , 75 , 77 , 79 , 81 , 120 , 126 ], [ [136] , [137] , [138] , [139] , [140] , [141] , [142] , [143] , [144] , [145] , [146] , [147] , [148] , [149] , [150] , [151] , [152] , [153] , [154] , [155] , [156] , [157] , [158] , [159] , [160] ]. Twenty-four of those studies included a control group representing overall 1399 participants [ 21 , 34 , 57 , 63 , 66 , 69 , 72 , 73 , 75 , 79 , ...…”

“…Fourteen studies included data on T-cell immunity, assessed through an ELISpot assay [ [56] , [57] , [58] , 62 , 65 , 75 , 81 ], flow cytometry [ 21 , 34 , 63 , 72 , 79 ] or an IGRA assay [ 21 , 66 ]. Most studies found lower non-response rates in cellular than in antibody response [ [56] , [57] , [58] , 62 , 63 , 72 , 79 , 81 ], while two studies found higher non-response rates in cellular than in antibody response [ 21 , 65 ].…”

Der Einfluss von Immunsuppression und chronischen Nierenerkrankungen auf das Ansprechen auf COVID-19-Impfungen

“…Die Höhe neutralisierender Antikörper, welche mit gemessenen Antikörpern gegen das Spike-Protein (häu-figster Antikörpernachweis) korrelieren, scheint mit einer Protektion vor symptomatischer Erkrankung assoziiert zu sein [10]. Weitere Studien untersuchten auch die zelluläre Immunität nach mRNA-Impfung [11,12] [16,17]. Daraus ergibt sich die Frage, ab wann und mit welchen Vakzinen Booster-Impfungen angeboten werden sollten, um Reinfektionen zu verhindern, insbesondere gegen "variants of concern" (VOC), zumal derartige Reinfektionen schwerwiegend verlaufen können.…”

“…figster Antikörpernachweis) korrelieren, scheint mit einer Protektion vor symptomatischer Erkrankung assoziiert zu sein[10]. Weitere Studien untersuchten auch die zelluläre Immunität nach mRNA-Impfung[11,12]. Unter 117 Nieren-/Nieren-Pankreas-transplantierten Patienten entwickelten 65 % eine humorale oder zelluläre Immunität, von denen 29,9 % Antikörper und 35 % T-Zellen aufwiesen.…”