SARS-CoV-2 anti-spike antibodies after a fourth dose of COVID-19 vaccine in adult solid-organ transplant recipients

Perrier, Quentin; Lupob, Julien; Gerster, Théophile; Augier, Caroline; Falque, L.; Rostaing, Lionel; Pelletier, Laurent; Bedouch, Pierrick; Blanc, M.; Saint-Raymond, Christel; Boignard, Aude; Bonadona, Agnès; Noble, Johan; Épaulard, Olivier

doi:10.1016/j.vaccine.2022.08.065

Cited by 23 publications

(38 citation statements)

References 37 publications

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“…However, females are known to have more robust immune responses to antigens due to the effects of sex hormones and X-linked genes (66,67), and we cannot exclude that our finding is due to confounding factors that we have not accounted for. Kidney or lung transplant recipients were associated with the humoral non response but not with the T-cell non response, which corroborates well with previous reports (10,18,34,68,69). In our study, kidney transplant recipients had the highest proportion of cardiovascular diseases, and lung transplant recipients more commonly received CNI/mTOR inhibitors and corticosteroids, which could partly explain the differences in the immune response.…”

Section: Discussionsupporting

confidence: 92%

“…Vaccination is an effective and evidence-based strategy to curb the severe acute respiratory coronavirus 2 (SARS-CoV-2) pandemic (1). However, it has been shown that the immune response to SARS-CoV-2 vaccination in immunocompromised persons is lower than in controls (2-5), and solid-organ transplant (SOT) recipients have impaired immune response to SARS-CoV-2 vaccination even after the third or fourth vaccine doses (3,(6)(7)(8)(9)(10)(11). Previous studies that investigated the immune response to SARS-CoV-2 vaccination in SOT recipients have focused on humoral immune responses, mainly on anti-SARS-CoV-2 IgG antibodies, with longitudinal follow-ups shorter than six months after first or second vaccine doses (12)(13)(14)(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

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Humoral and T-cell response 12 months after the first BNT162b2 vaccination in solid organ transplant recipients and controls: Kinetics, associated factors, and role of SARS-CoV-2 infection

et al. 2023

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IntroductionWe investigated humoral and T-cell responses within 12 months after first BNT162b2 vaccine in solid organ transplant (SOT) recipients and controls who had received at least three vaccine doses. Furthermore, we compared the immune response in participants with and without previous SARS-CoV-2 infection.MethodsWe included adult liver, lung, and kidney transplant recipients, and controls were selected from a parallel cohort of healthcare workers.ResultsAt 12th-month, the IgG geometric mean concentrations (GMCs) (P<0.001), IgA GMCs (P=0.003), and median IFN-γ (P<0.001) were lower in SOT recipients than in controls. However, in SOT recipients and controls with previous infection, the neutralizing index was 99%, and the IgG, and IgA responses were comparable. After adjustment, female-sex (aOR: 3.6, P<0.009), kidney (aOR: 7.0, P= 0.008) or lung transplantation (aOR: 7.5, P= 0.014), and use of mycophenolate (aOR: 5.2, P=0.03) were associated with low IgG non response. Age (OR:1.4, P=0.038), time from transplantation to first vaccine (OR: 0.45, P<0.035), and previous SARS-CoV-2 infection (OR: 0.14, P<0.001), were associated with low IgA non response. Diabetes (OR:2.4, P=0.044) was associated with T-cell non response.ConclusionIn conclusion, humoral and T-cell responses were inferior in SOT recipients without previous SARS-CoV-2 infection but comparable to controls in SOT recipients with previous infection.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Humoral and T-cell response 12 months after the first BNT162b2 vaccination in solid organ transplant recipients and controls: Kinetics, associated factors, and role of SARS-CoV-2 infection

et al. 2023

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“…One study demonstrated different serological responses according to the evidence of a prior infection with SARS-CoV-2 before the fourth dose ( 37 ), reporting higher antibodies levels in patients with history of coronavirus infection. Another study pointed out a weaker serological response in patients who remained seronegative after the third dose ( 30 ).…”

Section: Resultsmentioning

confidence: 99%

Humoral response after a fourth dose of SARS-CoV-2 vaccine in immunocompromised patients. Results of a systematic review

Martinelli

Pascucci

Laurenti

2023

Front. Public Health

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Background and objectiveThe fourth dose the COVID-19 vaccine was first proposed to immunocompromised patients. The aim of the article is to systematically review the literature and report the humoral response and outcomes after the fourth dose administration in people with impaired immune system.MethodsPublished studies on the humoral response, efficacy and safety of the fourth dose of the COVID-19 vaccine were analyzed in various settings of immunocompromised patients. We conducted systematic searches of PubMed, Cochrane Library and WHO COVID-19 Research Database for series published through January 31, 2023, using the search terms “fourth dose” or “second booster” or “4th dose” and “Coronavirus” or “COVID-19” or “SARS-CoV-2.” All articles were selected according to the PRISMA guidelines.ResultsA total of 24 articles including 2,838 patients were comprised in the systematic review. All the studies involved immunocompromised patients, including solid organ transplant recipients, patients with autoimmune rheumatic disease, patients with human immunodeficiency virus (HIV) and patients with blood cancers or diseases. Almost all patients received BNT162b2 or mRNA-1273 as fourth dose. All the studies demonstrated the increase of antibody titers after the fourth dose, both in patients who had a serological strong response and in those who had a weak response after the third dose. No serious adverse events after the 4th dose have been reported by 13 studies. COVID-19 infection after the fourth dose ranged from 0 to 21%.ConclusionThe present review highlights the importance of the fourth dose of covid-19 vaccines for immunocompromised patients. Across the included studies, a fourth dose was associated with improved seroconversion and antibody titer levels. In particular, a fourth dose was associated with increasing immunogenicity in organ transplant recipients and patients with hematological cancers, with a very low rate of serious side effects.

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“…Our protocol does not entertain rapid steroid withdrawal or avoidance. Previous studies 24,[59][60][61] (in adult transplant populations) has denoted the impact of some immunosuppressive medications such as mycophenolate on vaccine responsiveness. This was not evident in our pediatric cohort.…”

Section: Responders* (N = 43) P-valuementioning

confidence: 99%

“…The effectiveness of COVID-19 vaccines has been evaluated in adult transplant population; however, the data are very limited in their pediatric solid organ transplant (SOT) counterparts. [24][25][26][27] SOT recipients may have lower antibody responses due to immunosuppressive medications. Similarly, waning titers to other routine vaccines are well described following transplantation.…”

Section: Introductionmentioning

confidence: 99%

Coronavirus disease 2019 vaccine in pediatric post‐kidney transplantation

Ajlan

Aleid

Ali

et al. 2023

Clinical Transplantation

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Background Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infections and the resulting disease, coronavirus disease 2019 (COVID‐19), have spread to millions of persons worldwide. Many vaccines have been developed; however, their efficacy in pediatric solid organ transplant recipients is yet to be determined. Methods This is a prospective observational, non‐interventional single‐center study on the safety and efficacy of a COVID‐19 vaccine (BNT162b2) in pediatric kidney transplant recipients. The primary aim of this study was to evaluate immunogenicity according to SARS‐CoV‐2‐specific neutralizing antibody titer after two vaccine doses. The secondary aims were to investigate the safety of the vaccines, solicited local and systemic adverse reactions, incidence of COVID‐19 post‐vaccination, and effects on transplant graft function. Baseline investigations were conducted on pediatric renal transplant recipients, and recruited participants were advised to have the Comirnaty® mRNA vaccine according to protocol. Results A total of 48 patients (male, n = 31, 64.6%; female, n = 17, 35.4%), median age 14 [12–16] years were included, and all received two doses of the vaccine. The vaccine had a favorable safety and side‐effect profile. The S‐antibody titer of all patients ranged between .4 and 2,500 U/ml and was > 50 U/ml in 89% of the patients. No difference in the measured antibody immune response was noted between infected and uninfected children. No major side effects were reported. Conclusion The vaccine had a favorable safety profile in 12‐ to 15‐year‐old kidney transplant recipients, producing a greater measured antibody response than that in older transplant recipients.

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SARS-CoV-2 anti-spike antibodies after a fourth dose of COVID-19 vaccine in adult solid-organ transplant recipients

Cited by 23 publications

References 37 publications

Humoral and T-cell response 12 months after the first BNT162b2 vaccination in solid organ transplant recipients and controls: Kinetics, associated factors, and role of SARS-CoV-2 infection

Humoral and T-cell response 12 months after the first BNT162b2 vaccination in solid organ transplant recipients and controls: Kinetics, associated factors, and role of SARS-CoV-2 infection

Humoral response after a fourth dose of SARS-CoV-2 vaccine in immunocompromised patients. Results of a systematic review

Coronavirus disease 2019 vaccine in pediatric post‐kidney transplantation

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