Early humoral response among lung transplant recipients vaccinated with BNT162b2 vaccine

Shostak, Yael; Shafran, Noa; Heching, Moshe; Rosengarten, Dror; Shtraichman, Osnat; Shitenberg, Dorit; Amor, Shai M.; Yahav, Dafna; Zvi, Haim Ben; Pertzov, Barak; Kramer, Mordechai R

doi:10.1016/s2213-2600(21)00184-3

Cited by 68 publications

(90 citation statements)

References 4 publications

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“…This is because of blunted immune response of transplant patients most likely due to taking immunosuppressive medications. While antibody titers may develop, these usually develop late, are below the protective threshold, and unfortunately wane faster [54,55]. The observed failure to mount appreciable antibody immune response of transplant recipients is consistent in previous findings exploring other common vaccines [56].…”

Section: It Is Thought That Vaccination Could Trigger T-and B-cell Responses To Vaccine Antigens Thatsupporting

confidence: 88%

Effects of Age, Sex, Serostatus and Underlying Comorbidities on Humoral Response Post-SARS-CoV-2 Pfizer-BioNTech Vaccination – A Systematic Review

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Velasco

et al. 2021

Preprint

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With the advent of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic, several vaccines have been developed to mitigate its spread and prevent adverse consequences of the Coronavirus Disease 2019 (COVID-19). The mRNA technology is an unprecedented vaccine, usually given in two doses to prevent SARS-CoV-2 infections. Despite effectiveness and safety, inter-individual immune response heterogeneity has been observed in recipients of mRNA-based vaccines. As a novel disease, the specific immune response mechanism responsible for warding off COVID-19 remains unclear at this point. However, significant evidence suggests that humoral response plays a crucial role in affording immunoprotection and preventing debilitating sequelae from COVID-19. As such this paper focused on the possible effects of age, sex, serostatus, and comorbidities on humoral response (i.e., total antibodies, IgG and/or IgA) of different populations post-mRNA-based Pfizer-BioNTech vaccination. A systematic search of literature was performed through PubMed, Cochrane CENTRAL, and Google Scholar. Studies were included if they reported humoral response to COVID-19 mRNA vaccines. A total of 32 studies was identified and reviewed, and the percent difference of means of reported antibody levels were calculated for comparison. Findings revealed that older individuals, the male sex, seronegativity, and those with more comorbidities mounted less humoral immune response. Given these findings, several recommendations were proposed regarding the current vaccination practices. These include giving additional doses of vaccination for immunocompromised and elderly populations. Another recommendation is conducting clinical trials in giving a combined scheme of mRNA vaccines, protein vaccines, and vector-based vaccines.

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Section: It Is Thought That Vaccination Could Trigger T-and B-cell Responses To Vaccine Antigens Thatsupporting

confidence: 88%

Effects of Age, Sex, Serostatus and Underlying Comorbidities on Humoral Response Post-SARS-CoV-2 Pfizer-BioNTech Vaccination – A Systematic Review

Notarte

Ver

Velasco

et al. 2021

Preprint

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“…However, 4 out of the 12 did show a specific T cell response. In a larger study from Israel in 168 lung transplant recipients, just 18% had positive S-IgG titers within 3 weeks after the second vaccine dose [100]. Differences among vaccine types were also observed.…”

Section: Covid-19 Vaccination For Lung Transplant Recipientsmentioning

confidence: 95%

“…As many more patients received their vaccination, it was soon evident that the majority of solid organ transplant recipients, including lung transplants, have impaired immune responses [99][100][101][102][103][104][105][106][107][108]. In a small study by Havlin et al [99], none of the 12 lung transplant patients tested after two doses of the mRNA BNT162b2 vaccine developed anti-SARS-CoV-2 IgG.…”

Section: Covid-19 Vaccination For Lung Transplant Recipientsmentioning

confidence: 99%

Vaccination and their importance for lung transplant recipients in a COVID-19 world

Scharringa

Hoffman

Kessel

et al. 2021

Expert Review of Clinical Pharmacology

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Introduction: Lung transplant patients are immunocompromised because of the medication they receive to prevent rejection, and as a consequence are susceptible to (respiratory) infections. Adequate vaccination strategies, including COVID-19 vaccination, are therefore needed to minimize infection risks.Areas covered: The international vaccination guidelines for lung transplant patients are reviewed, including the data on immunogenicity and effectivity of the vaccines. The impact on response to vaccination of the various categories of immunosuppressive drugs, used in the posttransplant period, on response to vaccination is described. A number of immunosuppressive and/or anti-inflammatory drugs also is used for controlling the immunopathology of severe COVID-19. Current available COVID-19 vaccines, both mRNA or adenovirus based are recommended for lung transplant patients. Expert opinion:In order to improve survival and quality of life, infections of lung transplant patients should be prevented by vaccination. When possible, vaccination should start already during the pre-transplantation period when the patient is on the waiting list. Booster vaccinations should be given post-transplantation, but only when immunosuppression has been tapered. Vaccine design based on mRNA technology could allow the design of an array of vaccines against other respiratory viruses, offering a better protection for lung transplant patients.

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“…Several studies from Israel demonstrated low rates of antibody response to the BNT162b2 vaccine among solid organ transplant recipients, including 36% seropositivity among 308 kidney transplant recipients 2–4 weeks after the second vaccine dose 12 ; 47% seropositivity among 80 liver transplant recipients 13 ; 49% among 37 heart transplant recipients 14 ; and 18% among 168 lung transplant recipients. 15 Most demonstrated an association between mycophenolic acid dose and calcineurin inhibitor blood levels and antibody response. A large study evaluating response to either BNT162b2 vaccine or the mRNA-1273 (Moderna) vaccine among 658 organ transplant recipients also demonstrated low seropositivity rates of 54% a median of 29 days after two vaccine doses.…”

Section: Introductionmentioning

confidence: 99%

Immunosuppression reduction when administering a booster dose of the BNT162b2 mRNA SARS-CoV-2 vaccine in kidney transplant recipients without adequate humoral response following two vaccine doses: protocol for a randomised controlled trial (BECAME study)

et al. 2021

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IntroductionInadequate antibody response to mRNA SARS-CoV-2 vaccination has been described among kidney transplant recipients. Immunosuppression level and specifically, use of antimetabolite in the maintenance immunosuppressive regimen, are associated with inadequate response. In light of the severe consequences of COVID-19 in solid organ transplant recipients, we believe it is justified to examine new vaccination strategies in these patients.Methods and analysisBECAME is a single-centre, open-label, investigator-initiated randomised controlled, superiority trial, aiming to compare immunosuppression reduction combined with a third BNT162b2 vaccine dose versus third dose alone. The primary outcome will be seropositivity rate against SARS-CoV-2. A sample size of 154 patients was calculated for the seropositivity endpoint assuming 25% seropositivity in the control group and 50% in the intervention group. A sample of participants per arm will be also tested for T-cell response. We also plan to perform a prospective observational study, evaluating seropositivity among ~350 kidney transplant recipients consenting to receive a third vaccine dose, who are not eligible for the randomised controlled trial.Ethics and disseminationThe trial is approved by local ethics committee of Rabin Medical Center (RMC-0192-21). All participants will be required to provide written informed consent. Results of this trial will be published; trial data will be available. Protocol amendments will be submitted to the local ethics committee.Trail registration numberNCT04961229.

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Early humoral response among lung transplant recipients vaccinated with BNT162b2 vaccine

Cited by 68 publications

References 4 publications

Effects of Age, Sex, Serostatus and Underlying Comorbidities on Humoral Response Post-SARS-CoV-2 Pfizer-BioNTech Vaccination – A Systematic Review

Effects of Age, Sex, Serostatus and Underlying Comorbidities on Humoral Response Post-SARS-CoV-2 Pfizer-BioNTech Vaccination – A Systematic Review

Vaccination and their importance for lung transplant recipients in a COVID-19 world

Immunosuppression reduction when administering a booster dose of the BNT162b2 mRNA SARS-CoV-2 vaccine in kidney transplant recipients without adequate humoral response following two vaccine doses: protocol for a randomised controlled trial (BECAME study)

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