Is There a Difference in Immune Response to SARS-CoV-2 Vaccination between Liver and Lung Transplant Patients with Cystic Fibrosis?

Abstract

People with Cystic Fibrosis (CF), especially solid organ transplant recipients, have been prioritized in the SARS-CoV-2 vaccination program. This study assesses antibody response of patients with CF who have undergone liver (CF-LI) or lung (CF-LU) transplantation, and compares results to published data of patients with solid organ transplantation without CF as underlying disease. Antibodies against the spike receptor-binding domain were measured within the routine visits at the CF Centre in Innsbruck, Austria, after the second and third doses of SARS-CoV-2 mRNA vaccines. We report on 13 adult CF patients who are recipients of solid organ transplant, including five CF-LI and eight CF-LU. Overall, 69% had measurable antibody response after two, and 83% after three doses of SARS-CoV-2 vaccines. In CF-LI, positive serological response amounted to 100% after two and three doses, while CF-LU showed only a 50% and a 71% response rate, respectively. Clear differences are seen between the CF-LI and CF-LU groups in our cohort, with worse response rate for lung transplant recipients. Immune response between CF-LI and CF-LU, therefore, must be considered in a differentiated manner, and the importance of booster vaccination is once more emphasized with these data.

Long-Term Assessment of Antibody Response to COVID-19 Vaccination in People with Cystic Fibrosis and Solid Organ Transplantation

“…As described in our previous study, overall, 83.6% of our patients had a detectable antibody response after three doses of the SARS-CoV-2 mRNA vaccine, where the response of CF-LI was clearly stronger than that of CF-LU [14]. Looking at both S1RBD and IgG trends in this study, there is an obvious decrease in the first months after the third vaccination in both groups, accompanied by an increase in CF-LI and a stabilization in lung-transplanted patients.…”

“…All patients were vaccinated at least three times with a SARS-CoV-2 mRNA vaccine (30 µg Comirnaty and/or 100 µg Spikevax) in 2021 and 2022, respectively. Regarding side effects and COVID-19 infections during this period, we refer to our primary study [ 14 ]. Only four patients (33.3%) received a fourth vaccination in winter 2022/2023 (30 µg Comirnaty).…”

“…We recently reported short-term antibody response of CF patients who had undergone liver (CF-LI) or lung (CF-LU) transplantation, following two or three COVID-19 vaccination doses [ 14 ]. We compared levels to recipients of solid organ transplants without CF as an underlying disease and could show higher rates of serological response in CF patients.…”

“…We compared levels to recipients of solid organ transplants without CF as an underlying disease and could show higher rates of serological response in CF patients. We could also show that antibody levels in the CF-LI group were generally higher than in the CF-LU group, presumably due to the lower immunosuppression and lack of mycophenolate mofetil therapy [ 14 ]. Data on immune response to SARS-CoV-2 mRNA vaccination in CF patients with solid organ transplantation are limited, especially regarding long-term efficacy.…”