Characteristics and outcomes among vaccinated lung transplant patients with breakthrough COVID‐19

Abstract

Background: Despite multiple studies evaluating the immunological responsiveness to vaccines, the clinical effectiveness of the two-dose mRNA vaccine schedule among lung transplant (LT) patients has not been evaluated. Methods:We included LT patients who tested positive for SARS-CoV-2 on a nasopharyngeal swab between March 1, 2020, and August 25, 2021 (n = 70). The study group was divided based on their vaccination status.Results: During the study period, 14 fully vaccinated LT patients with one of the mRNA vaccines tested positive for COVID-19 (median age 54, range 30-62 years, M:F 9:5).The vaccinated cohort was younger with bilateral LT, have suppurative conditions as the transplant indication, and present with milder symptoms. However, pulmonary parenchymal involvement was seen among all 12 patients where computed tomography (CT) of chest was available. The laboratory profile indicated a more subdued inflammatory response among the vaccinated group.A lower proportion of vaccinated patients developed respiratory failure, needed ICU admission or ventilator support, although none of the differences achieved statistical significance. None of the vaccinated patients succumbed to COVID-19 during the study period, while the 4-week mortality among unvaccinated patients was nearly 15% (8/56). Conclusions:In this cohort of vaccinated LT patients who developed breakthrough COVID-19, the clinical course, risk of complications, and outcomes trended better than unvaccinated patients. However, universal involvement of the allograft demonstrates the continued vulnerability of these patients to significant sequelae from COVID-19.Future studies may evaluate the incremental protection of vaccination after the completion of the third dose of mRNA vaccines among LT patients.

Vaccination Against SARS-CoV-2 in Lung Transplant Recipients: Immunogenicity, Efficacy and Safety

“…A single-center retrospective study by Bolinelli et al. was designed to evaluate the clinical effectiveness of COVID-19 vaccines in LuTx patients by assessing the respiratory symptoms, oxygen saturations, imaging findings and other clinical variables, in SARS-CoV-2 positive LuTx patients with/without COVID-19 vaccination ( 30 ). The study has shown lower levels of inflammatory markers during the acute phase of COVID-19 and lower risk of COVID-19 complications, such as respiratory failure or ventilation need, in vaccinated individuals.…”

Epidemiological and clinical characteristics of vaccinated COVID-19 patients: A meta-analysis and systematic review

“…A total of 14 studies were included to analyze the effect of age. We found no statistical difference in the age of the two groups (SMD = 0.085, 95% CI = À0.073-0.189, p = 0.388, 12 Case-control study 346 1100 ☆☆☆ ☆☆ ☆☆ 7☆ Wi 18 Case-control study 142 20 ☆☆ ☆☆ ☆☆ 6☆ Tenforde 13 Case-control study 314 1669 ☆☆☆ ☆☆ ☆☆ 7☆ Hsu 19 Case-control study 85 85 ☆☆ ☆☆ ☆☆☆ 7☆ Blanquart 20 Case-control study 724 5459 ☆☆☆ ☆☆ ☆☆ 7☆ Bollineni 21 Case-control study 14 56 ☆ ☆☆ ☆☆☆ 6☆ Marincu 22 Case-control study 62 62 ☆☆ ☆☆ ☆☆☆ 7☆ Wolff 23 Case-control study 260 507 ☆☆☆ ☆☆ ☆☆☆ 8☆ Kalligeros 24 Case-control study 91 824 ☆☆☆ ☆☆ ☆☆☆ 8☆ Fragoulis 25 Cohort study 101 60 ☆☆☆ ☆☆ ☆☆☆ 8☆ Trunfio 26 Cohort study 55 110 ☆☆☆ ☆☆ ☆☆ 7☆ Safdar 27 Cohort study 45 65 ☆☆☆ ☆☆ ☆☆☆ 8☆ Bouton 28 Cohort study 96 329 ☆☆ ☆☆ ☆☆☆ 7☆ Bosch 29 Case-control study 126 839 ☆☆ ☆☆ ☆☆☆ 7☆ Christensen 30 Case-control study 3346 13,619 ☆☆☆ ☆☆ ☆☆☆ 8☆ Yu 31 Case-control study 23 50 ☆☆☆ ☆☆ ☆☆☆ 8☆ Bayhan 32 Case-control study 38 190 ☆☆☆ ☆☆ ☆☆☆ 8☆ Kustin 33 Case-control study 396 396 ☆☆ ☆☆ ☆☆ 6☆ Toda 34 Case-control study 11 15 ☆☆☆ ☆☆ ☆☆☆ 8☆ Tian 4 Case-control study 88 41 ☆☆☆ ☆☆ ☆☆☆ 8☆ Sayed 35 Case-control study 50 70 ☆☆☆ ☆☆ ☆☆☆ 8☆ Lee 36 Case-control study 174 587 ☆☆☆ ☆☆ ☆☆☆ 8☆ Luo 37 Case-control study 484 1782 ☆☆☆ ☆☆ ☆☆ 7☆ Puhach 38 Case-control study 139 245 ☆☆ ☆☆ ☆☆ 6☆ Whittaker 39 Case-control study 716 2487 ☆☆☆ ☆☆ ☆☆☆ 8☆ Sanghavi 40 Case-control study 149 478 ☆☆☆ ☆☆ ☆☆☆ 8☆ Butt (1) 41 Case-control study 250 250 ☆☆☆ ☆☆ ☆☆☆ 8☆ Butt (2) 42 Case-control study 456 456 ☆☆☆ ☆☆ ☆☆☆ 8☆ Spiera 43 Case-control study 88 2317 ☆☆ ☆☆ ☆☆☆ 7☆ Baltas 44 Case-control study 119 476 ☆☆☆ ☆☆ ☆☆ 7☆ John 45 Case-control study 254 508 ☆☆ ☆☆ ☆☆ 6☆ Jacobson 46 Case-control study 189 471 ☆☆ ☆☆ ☆☆ 6☆ Estofolete …”

Cowpox to COVID: History of vaccination in the immunocompromised host

“…Comparison of vaccinated versus unvaccinated immunocompromised hosts demonstrated a decreased risk of contracting COVID with an incidence of 3.9% in the vaccinated compared with 11.8% of unvaccinated among patients at risk 106 . A small study of lung transplant patients demonstrated that patients with breakthrough infection who were vaccinated nonetheless demonstrated milder symptoms compared with unvaccinated patients 110 . The impact of the new bivalent mRNA vaccine with original and omicron BA.4/BA.5 antigens on protection against newer COVID‐19 variants remains to be determined.…”

“…106 A small study of lung transplant patients demonstrated that patients with breakthrough infection who were vaccinated nonetheless demonstrated milder symptoms compared with unvaccinated patients. 110 The impact of the new bivalent mRNA vaccine with original and omicron BA.4/BA.5 antigens on protection against newer COVID-19 variants remains to be determined.…”

“…Despite impaired humoral immune response, clinical data are accumulating showing the benefit of vaccination in terms of reducing the incidence of severe COVID‐19 disease and death, 105–110 although breakthrough infection continues to be an issue, especially with new variant strains, including omicron 111,112 . Comparison of vaccinated versus unvaccinated immunocompromised hosts demonstrated a decreased risk of contracting COVID with an incidence of 3.9% in the vaccinated compared with 11.8% of unvaccinated among patients at risk 106 .…”