Lung Transplant Recipients Immunogenicity after Heterologous ChAdOx1 nCoV-19—BNT162b2 mRNA Vaccination

Abstract

(1) Background: High immunosuppressive regimen in lung transplant recipients (LTRs) hampers the immune response to vaccination. We prospectively investigated the immunogenicity of heterologous ChAdOx1 nCoV-19-BNT162b2 mRNA vaccination in an LTR cohort. (2) Methods: Forty-nine COVID-19 naïve LTRs received a two-dose regimen ChAdOx1 nCoV-19 vaccine. A subset of 32 patients received a booster dose of BNT162b2 mRNA vaccine 18 weeks after the second dose. (3) Results: Two-doses of ChAdOx1 nCoV-19 induced poor immunogenicity with 7.2% seropositivity at day 180 and low neutralizing capacities. The BNT162b2 mRNA vaccine induced significant increases in IgG titers with means of 197.8 binding antibody units per milliliter (BAU/mL) (95% CI 0–491.4) and neutralizing antibodies, with means of 76.6 AU/mL (95% CI 0–159.6). At day 238, 32.2% of LTRs seroconverted after the booster dose. Seroneutralization capacities against Delta and Omicron variants were found in only 13 and 9 LTRs, respectively. Mycophenolate mofetil and high-dose corticosteroids were associated with a weak serological response. (4) Conclusions: The immunogenicity of a two-dose ChAdOx1 nCoV-19 vaccine regimen was very poor in LTRs, but was significantly enhanced after the booster dose in one-third of LTRs. In immunocompromised individuals, the administration of a fourth dose may be considered to increase the immune response against SARS-CoV-2.

Evaluation of Immunogenicity to Three Doses of the SARS-CoV-2 BNT162b2 mRNA Vaccine in Lung Transplant Patients

“…Overall, our data are in line with other authors [ 18 , 19 , 20 ], showing an almost complete lack of anti-SARS-CoV-2 antibody response in LuT patients before the booster dose. On the other hand, as reported in a recent work by Catry et al [ 21 ], the third dose induces an increase in the seroconversion rate, underlining its potential benefit, at least within two months from vaccine boosting.…”

The immunologic outcomes and adverse events of COVID-19 vaccine booster dose in immunosuppressed people: A systematic review

“…Although the disease has affected all groups of people, those with chronic comorbidities are among the most vulnerable individuals ( Guven et al, 2023 , Mehraeen et al, 2022 ). Certain populations ( Balsby et al, 2022 ) including solid organ transplant recipients (SOTR) such as those who have undergone kidney ( Affeldt et al, 2022 , Brandstetter et al, 2022 , Hod et al, 2022 , Schrezenmeier et al, 2022 , Thotsiri et al, 2022 ), liver ( Davidov et al, 2022 , Sriphoosanaphan et al, 2022 ), lung ( Catry et al, 2022 ) and heart transplants ( Peled et al, 2022 ) as well as patients with conditions like immune-mediated inflammatory diseases and multiple sclerosis who receive immunosuppressive treatments ( Bjørlykke et al, 2023 , Smetanova et al, 2022 , Wroński et al, 2022 ), face greater disease severity. Furthermore, patients diagnosed with various malignancies ( Benitez Fuentes et al, 2022 , Diamantopoulos et al, 2022 , Goldwater et al, 2023 , Ollila et al, 2022 , Storti et al, 2022 , Tanzilli et al, 2022 , Terpos et al, 2022 ) or immune deficiencies ( Fidler et al, 2023 , Gianserra et al, 2022 , Kling et al, 2023 ) experience a more severe course of illness due to a combination of their immunosuppressive medications and the nature of their underlying condition.…”

“…The effectiveness of COVID-19 vaccines in preventing SARS-CoV-2 infection and diminishing the severity of the disease has been established ( Lin et al, 2022 , Dadras et al, 2022 ). Since the immune response subsides after several months after vaccination, especially with the emergence of new fast spreading variants of concern (VOCs) like Omicron variant ( Peled et al, 2022 , Kling et al, 2023 ), periodic heterologous or homologous booster doses are essential to ensure efficient and long-lasting protection against COVID-19 ( Sriphoosanaphan et al, 2022 , Catry et al, 2022 , Guven et al, 2023 , Peled et al, 2022 ).…”

Vaccine‐induced binding and neutralizing antibodies against Omicron 6 months after a homologous BNT162b2 booster

“…15 This variant is characterized by 32 dominant mutations in the spike (S) protein, 15 of which are located in the receptor‐binding domain (RBD) conferring an increased transmissibility and a considerable immune escape from acquired protection through SARS‐CoV‐2 vaccination or a previous infection. 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 Currently, Omicron is largely dominant and several subvariants have emerged including BA.2, BA.2.12.1, BA.4, and BA.5. 15 All these subvariants have also demonstrated a considerable escape to acquired immunity.…”

“…Discovered in November 2021, the Omicron lineage is to date the leading variant over the world 15 . This variant is characterized by 32 dominant mutations in the spike (S) protein, 15 of which are located in the receptor‐binding domain (RBD) conferring an increased transmissibility and a considerable immune escape from acquired protection through SARS‐CoV‐2 vaccination or a previous infection 17–24 . Currently, Omicron is largely dominant and several subvariants have emerged including BA.2, BA.2.12.1, BA.4, and BA.5 15 .…”