Safety and Immunogenicity of a Third Dose of SARS-CoV-2 Vaccine in Solid Organ Transplant Recipients: A Case Series

Werbel, William A; Boyarsky, Brian J.; Ou, Michael T.; Massie, Allan B.; Tobian, Aaron A.R.; Garonzik-Wang, Jacqueline M; Segev, Dorry L.

doi:10.7326/l21-0282

Cited by 311 publications

(366 citation statements)

References 4 publications

Supporting

Mentioning

311

Contrasting

Unclassified

Order By: Relevance

“…Interestingly, those KTRs with detectable SARS-CoV-2 antibodies levels after the second vaccination, showed an effective immune response after the third vaccination. 29 In contrast, the majority of patients with no detectable antibodies after the second vaccination did not benefit from the third vaccination.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Impaired Immune Response to SARS-CoV-2 Vaccination in Dialysis Patients and in Kidney Transplant Recipients

et al. 2021

View full text Add to dashboard Cite

Background: Kidney failure patients on dialysis or after renal transplantation have a high risk for severe COVID-19 infection and vaccination against SARS-CoV-2 is the only expedient prophylaxis. Generally, immune responses are attenuated in kidney failure patients, however, systematic analyses of immune responses to SARS-CoV-2 vaccination in dialysis patients and in kidney transplant recipients (KTR) are still missing. Methods: In this prospective multicentric cohort study, antibody responses COVID-19 mRNA vaccines (BNT162b2; Biontech/Pfizer or mRNA-1273; Moderna) were measured in 32 dialysis patients and in 28 KTRs. SARS-CoV-2-specific antibodies and neutralization capacity were evaluated and compared to controls (n=78) in a similar age-range. Results: After the first vaccination, SARS-CoV-2-specific antibodies were nearly undetectable in kidney failure patients. After the second vaccination, 93% of the controls and 88% of dialysis patients but only 37% of KTRs developed SARS-CoV-2-specific IgG above cut-off. Moreover, mean IgG levels were significantly lower in KTRs (54±93 BAU/ml) compared to dialysis patients (503±481 BAU/ml, p<0.01). Both KTRs as well as dialysis patients had significantly lower IgG levels compared to controls (1992±2485 BAU/ml; p<0.001 and p<0.01). Importantly, compared to controls, neutralizing antibody titers were significantly lower in KTRs and dialysis patients. After the second vaccination, 76% of KTRs did not show any neutralization capacity against SARS-CoV-2 suggesting impaired seroprotection. Conclusions: Kidney failure patients show a significantly weaker antibody response compared to controls. Most strikingly, only one out four KTRs developed neutralizing antibodies against SARS-CoV-2 after two doses of vaccine. These data suggest that vaccination strategies need modification in immune transplant and dialysis patients.

show abstract

Section: Discussionmentioning

confidence: 99%

“…In line with this suggestion, a recent observational study reported an additional effect of a third vaccination in KTRs with markedly attenuated antibody response after the second vaccination. 29 . In this study 6 of 30 KTRs (20%) had low detectable SARS-CoV-2 antibodies levels whereas the others did not show any response.…”

Section: Discussionmentioning

confidence: 99%

Impaired Immune Response to SARS-CoV-2 Vaccination in Dialysis Patients and in Kidney Transplant Recipients

et al. 2021

View full text Add to dashboard Cite

show abstract

“…The copyright holder for this preprint this version posted July 14, 2021. ; https://doi.org/10.1101/2021.07.11.21260338 doi: medRxiv preprint vaccination in transplant recipients indicate major impairments in vaccine-induced humoral and cellular immunity (16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Whether transplant recipients are uniquely vulnerable to more transmissible viral strains with spike protein variants, which are rising in prevalence globally, remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Vaccine serologic responses among transplant patients associate with COVID-19 infection and T peripheral helper cells

Lemieux

Gentili

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: Therapeutically immunosuppressed transplant recipients exhibit attenuated responses to COVID-19 vaccines. To better understand the immune alterations that determined poor vaccine response, we correlated quantities of circulating T and B cell subsets at baseline with longitudinal serologic responses to SARS-CoV-2 mRNA vaccination in heart and lung transplant recipients. Methods: Samples at baseline and at approximately 8 and 30 days after each vaccine dose for 22 heart and lung transplant recipients with no history of COVID-19, four heart and lung transplant recipients with prior COVID-19 infection, and 12 healthy controls undergoing vaccination were analyzed. Anti-spike protein receptor binding domain (RBD) IgG and pseudovirus neutralization activity were measured. Proportions of B and T cell subsets at baseline were comprehensively quantitated. Results: At 8-30 days post vaccination, healthy controls displayed robust anti-RBD IgG responses, whereas heart and lung transplant recipients showed minimally increased responses. A parallel absence of activity was observed in pseudovirus neutralization. In contrast, three of four (75%) transplant recipients with prior COVID-19 infection displayed robust responses at levels comparable to controls. Baseline levels of activated PD-1+ HLA-DR+ CXCR5- CD4+ T cells (also known as T peripheral helper [TPH] cells) and CD4+ T cells strongly predicted the ability to mount a response. Conclusions: Immunosuppressed patients have defective vaccine responses but can be induced to generate neutralizing antibodies after SARS-CoV-2 infection. Strong correlations of vaccine responsiveness with baseline TPH and CD4+ T cell numbers highlights a role for T helper activity in B cell differentiation into antibody secreting cells during vaccine response.

show abstract

“…Among those, 67% were still seronegative for SARS-CoV-2 RBD antibodies following a third vaccination with no treatment modification. 7 Therefore, if the virus neutralisation titres after SARS-CoV-2 vaccination are undetectable or low, it may be reasonable to consider temporary supervised reduction in the dose of immunosuppressive drugs prior and during the time of a second vaccination, to allow recovery of B and T cell function and a robust immune response to vaccination. This may be associated with risk that autoimmune diseases may relapse, or transplant rejection may occur.…”

mentioning

confidence: 99%

Pause in immunosuppressive treatment results in improved immune response to SARS-CoV-2 vaccine in autoimmune patient: a case report

et al. 2021

View full text Add to dashboard Cite

show abstract

Safety and Immunogenicity of a Third Dose of SARS-CoV-2 Vaccine in Solid Organ Transplant Recipients: A Case Series

Cited by 311 publications

References 4 publications

Impaired Immune Response to SARS-CoV-2 Vaccination in Dialysis Patients and in Kidney Transplant Recipients

Impaired Immune Response to SARS-CoV-2 Vaccination in Dialysis Patients and in Kidney Transplant Recipients

Vaccine serologic responses among transplant patients associate with COVID-19 infection and T peripheral helper cells

Pause in immunosuppressive treatment results in improved immune response to SARS-CoV-2 vaccine in autoimmune patient: a case report

Contact Info

Product

Resources

About