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Aihara R, Umemura K, Katada Y, Nakagawa S, Kobayashi T, Hatano E, Date H, Nagao M, Terada T. Investigation of severe acute respiratory syndrome coronavirus 2 infection status in solid organ transplant recipients treated with tixagevimab/cilgavimab. J Infect Chemother 2024:S1341-321X(24)00139-9. [PMID: 38777151 DOI: 10.1016/j.jiac.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/01/2024] [Accepted: 05/19/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Tixagevimab and cilgavimab (T/C) are neutralizing antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that can be used to prevent SARS-CoV-2 infection in solid organ transplant (SOT) recipients. However, their neutralizing activity against recent variants was reduced, raising concerns regarding the emergence of breakthrough coronavirus diseases 2019 (COVID-19). This study aimed to investigate the status of the COVID-19 breakthrough after T/C administration. METHODS We retrospectively investigated breakthrough COVID-19 in SOT recipients administered T/C at Kyoto University Hospital, Japan, from November 2022 to March 2023. Patients were monitored for 6 months after T/C administration. SARS-CoV-2 infection was diagnosed using polymerase chain reaction or antigen tests. The monthly incidence rates of SARS-CoV-2 infection were calculated using the person-time method. RESULTS T/C were administered to 67 SOT recipients (liver, 16; lung, 36; and kidney, 15), of whom five were infected with SARS-CoV-2. All five cases were classified as mild, and none of these patients required admission to the intensive care unit (ICU) or died. All infected individuals tested positive for SARS-CoV-2 after March 2023, when T/C-resistant subvariant strains became predominant. The monthly incidence rate of SARS-CoV-2 infection, calculated using the person-time method, suggested an increasing trend. CONCLUSIONS During the T/C-resistant variant epidemic, SARS-CoV-2 infections were identified even after T/C administration, suggesting that the prophylactic effects of T/C were invalid. Therefore, emerging variants must be carefully monitored and characterized to determine appropriate antiviral strategies, such as the use of suitable neutralizing antibodies.
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Affiliation(s)
- Ririka Aihara
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Keisuke Umemura
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshiki Katada
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan; Department of Infection Control and Prevention, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shunsaku Nakagawa
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takashi Kobayashi
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Etsuro Hatano
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Miki Nagao
- Department of Infection Control and Prevention, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan; Department of Clinical Laboratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Tomohiro Terada
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
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Meeraus W, Joy M, Ouwens M, Taylor KS, Venkatesan S, Dennis J, Tran TN, Dashtban A, Fan X, Williams R, Morris T, Carty L, Kar D, Hoang U, Feher M, Forbes A, Jamie G, Hinton W, Sanecka K, Byford R, Anand SN, Hobbs FDR, Clifton DA, Pollard AJ, Taylor S, de Lusignan S. AZD1222 effectiveness against severe COVID-19 in individuals with comorbidity or frailty: The RAVEN cohort study. J Infect 2024; 88:106129. [PMID: 38431156 DOI: 10.1016/j.jinf.2024.106129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/27/2023] [Accepted: 02/22/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES Despite being prioritized during initial COVID-19 vaccine rollout, vulnerable individuals at high risk of severe COVID-19 (hospitalization, intensive care unit admission, or death) remain underrepresented in vaccine effectiveness (VE) studies. The RAVEN cohort study (NCT05047822) assessed AZD1222 (ChAdOx1 nCov-19) two-dose primary series VE in vulnerable populations. METHODS Using the Oxford-Royal College of General Practitioners Clinical Informatics Digital Hub, linked to secondary care, death registration, and COVID-19 datasets in England, COVID-19 outcomes in 2021 were compared in vaccinated and unvaccinated individuals matched on age, sex, region, and multimorbidity. RESULTS Over 4.5 million AZD1222 recipients were matched (mean follow-up ∼5 months); 68% were ≥50 years, 57% had high multimorbidity. Overall, high VE against severe COVID-19 was demonstrated, with lower VE observed in vulnerable populations. VE against hospitalization was higher in the lowest multimorbidity quartile (91.1%; 95% CI: 90.1, 92.0) than the highest quartile (80.4%; 79.7, 81.1), and among individuals ≥65 years, higher in the 'fit' (86.2%; 84.5, 87.6) than the frailest (71.8%; 69.3, 74.2). VE against hospitalization was lowest in immunosuppressed individuals (64.6%; 60.7, 68.1). CONCLUSIONS Based on integrated and comprehensive UK health data, overall population-level VE with AZD1222 was high. VEs were notably lower in vulnerable groups, particularly the immunosuppressed.
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Affiliation(s)
- Wilhelmine Meeraus
- Medical Evidence, Vaccines & Immune Therapies, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
| | - Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mario Ouwens
- Medical & Payer Evidence Statistics, BioPharmaceuticals Medical, AstraZeneca, Mölndal, Sweden
| | - Kathryn S Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sudhir Venkatesan
- Medical & Payer Evidence Statistics, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
| | | | - Trung N Tran
- Biopharmaceutical Medicine Respiratory and Immunology, AstraZeneca, Gaithersburg, MD, USA
| | - Ashkan Dashtban
- Institute of Health Informatics, University College London, London, UK
| | - Xuejuan Fan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Robert Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tamsin Morris
- Medical and Scientific Affairs, BioPharmaceuticals Medical, AstraZeneca, London, UK
| | - Lucy Carty
- Medical & Payer Evidence Statistics, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
| | - Debasish Kar
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Uy Hoang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Michael Feher
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Anna Forbes
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Gavin Jamie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - William Hinton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kornelia Sanecka
- Medical Evidence, Vaccines & Immune Therapies, BioPharmaceuticals Medical, AstraZeneca, Warsaw, Poland
| | - Rachel Byford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sneha N Anand
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - David A Clifton
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Sylvia Taylor
- Medical Evidence, Vaccines & Immune Therapies, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; Royal College of General Practitioners Research and Surveillance Centre, London, UK.
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Yamanaga S, Shimata K, Ohfuji S, Yoshikawa M, Natori Y, Hibi T, Yuzawa K, Egawa H. Excess mortality in COVID-19-affected solid organ transplant recipients across the pandemic. Am J Transplant 2024:S1600-6135(24)00212-0. [PMID: 38514016 DOI: 10.1016/j.ajt.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 03/05/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024]
Abstract
The excess mortality of coronavirus disease 2019 (COVID-19) solid organ transplant recipients (SOTRs) throughout the pandemic remains unclear. This prospective cohort study based on the Japanese nationwide registry included 1632 SOTRs diagnosed with COVID-19 between February 1, 2020, and July 31, 2022, categorized based on dominant phases of variants of concern (VOCs): Waves 1 to 3 (Beta), 4 (Alpha), 5 (Delta), 6 (Omicron BA.1/BA.2), and 7 (Omicron BA.5). Excess mortality of COVID-19-affected SOTRs was analyzed by calculating standardized mortality ratios (SMRs). Overall, 1632 COVID-19-confirmed SOTRs included 1170 kidney, 408 liver, 25 lung, 20 heart, 1 small intestine, and 8 multiorgan recipients. Although disease severity and all-cause mortality decreased as VOCs transitioned, SMRs of SOTRs were consistently higher than those of the general population throughout the pandemic, showing a U-shaped gap that peaked toward the Omicron BA.5 phase; SMR (95% CI): 6.2 (3.1-12.5), 4.0 (1.5-10.6), 3.0 (1.3-6.7), 8.8 (5.3-14.5), and 21.9 (5.5-87.6) for Waves 1 to 3 (Beta), Wave 4 (Alpha), Wave 5 (Delta), Wave 6 (Omicron BA.1/2), and Wave 7 (Omicron BA.5), respectively. In conclusion, COVID-19 SOTRs had greater SMRs than the general population across the pandemic. Vaccine boosters, immunosuppression optimization, and other protective measures, particularly for older SOTRs, are paramount.
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Affiliation(s)
- Shigeyoshi Yamanaga
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, Nagamine-Minami, Higashi Ward, Kumamoto, Japan
| | - Keita Shimata
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Honjō, Chuo Ward, Kumamoto, Japan
| | - Satoko Ohfuji
- Department of Public Health, Osaka Metropolitan University Graduate School of Medicine, Asahimachi, Abeno Ward, Osaka, Japan
| | - Mikiko Yoshikawa
- Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kajiichō, Kamigyo Ward, Kyoto, Japan
| | - Yoichiro Natori
- Solid Organ Transplant Infectious Diseases, Miami Transplant Institute, Jackson Health System, Miami, Florida, USA; Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Honjō, Chuo Ward, Kumamoto, Japan.
| | - Kenji Yuzawa
- Department of Transplantation Surgery, National Hospital Organization Mito Medical Center, Sakuranosato, Ibaraki, Higashiibaraki District, Ibaraki, Japan
| | - Hiroto Egawa
- Department of Surgery, Tokyo Women's Medical University, Kawadacho, Shinjuku Ward, Tokyo, Japan
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Cavalera S, Di Nardo F, Serra T, Testa V, Baggiani C, Rosati S, Colitti B, Brienza L, Colasanto I, Nogarol C, Cosseddu D, Guiotto C, Anfossi L. A semi-quantitative visual lateral flow immunoassay for SARS-CoV-2 antibody detection for the follow-up of immune response to vaccination or recovery. J Mater Chem B 2024; 12:2139-2149. [PMID: 38315042 DOI: 10.1039/d3tb02895j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
The lateral flow immunoassay (LFIA) technique is largely employed for the point-of-care detection of antibodies especially for revealing the immune response in serum. Visual LFIAs usually provide the qualitative yes/no detection of antibodies, while quantification requires some equipment, making the assay more expensive and complicated. To achieve visual semi-quantification, the alignment of several lines (made of the same antigen) along a LFIA strip has been proposed. The numbering of the reacting lines has been used to correlate with the quantity of some biomarkers in serum. Here, we designed the first semiquantitative LFIA for detecting antibodies and applied it to classify the immune response to SARS-CoV-2 raised by vaccination or natural infection. We used a recombinant spike receptor-binding domain (RBD) as the specific capture reagent to draw two test lines. The detection reagent was selected among three possible ligands that are able to bind to anti-spike human antibodies: the same RBD, staphylococcal protein A, and anti-human immunoglobulin G antibodies. The most convenient detector, adsorbed on gold nanoparticles, was chosen based on the highest correlation with an antibody titre of 171 human sera, measured by a reference serological method, and was the RBD (Spearman's rho = 0.84). Incorporated into the semiquantitative LFIA, it confirmed the ability to discriminate high- and low-titre samples and to classify them into two classes (Dunn's test, P < 0.05). The proposed approach enabled the semiquantification of the immune response to SARS-CoV-2 by the unaided eye observation, thus overcoming the requirement of costly and complicated equipment, and represents a general strategy for the development of semiquantitative serological LFIAs.
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Affiliation(s)
- Simone Cavalera
- Department of Chemistry, University of Turin, Via Pietro Giuria 7, Turin, Italy.
| | - Fabio Di Nardo
- Department of Chemistry, University of Turin, Via Pietro Giuria 7, Turin, Italy.
| | - Thea Serra
- Department of Chemistry, University of Turin, Via Pietro Giuria 7, Turin, Italy.
| | - Valentina Testa
- Department of Chemistry, University of Turin, Via Pietro Giuria 7, Turin, Italy.
| | - Claudio Baggiani
- Department of Chemistry, University of Turin, Via Pietro Giuria 7, Turin, Italy.
| | - Sergio Rosati
- Department of Veterinary Science, University of Turin, Largo Braccini 2, Grugliasco (TO), Italy
| | - Barbara Colitti
- Department of Veterinary Science, University of Turin, Largo Braccini 2, Grugliasco (TO), Italy
| | - Ludovica Brienza
- Department of Veterinary Science, University of Turin, Largo Braccini 2, Grugliasco (TO), Italy
| | - Irene Colasanto
- Department of Veterinary Science, University of Turin, Largo Braccini 2, Grugliasco (TO), Italy
| | - Chiara Nogarol
- In3diagnostic srl, Largo Braccini 2, Grugliasco (TO), Italy
| | - Domenico Cosseddu
- A.O. Ordine Mauriziano, Ospedale Umberto I di Torino, Via Magellano 1, Turin, Italy
| | - Cristina Guiotto
- A.O. Ordine Mauriziano, Ospedale Umberto I di Torino, Via Magellano 1, Turin, Italy
| | - Laura Anfossi
- Department of Chemistry, University of Turin, Via Pietro Giuria 7, Turin, Italy.
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Fuchs T, Appelt D, Ellemunter H. Long-Term Assessment of Antibody Response to COVID-19 Vaccination in People with Cystic Fibrosis and Solid Organ Transplantation. Vaccines (Basel) 2024; 12:98. [PMID: 38250911 PMCID: PMC10819632 DOI: 10.3390/vaccines12010098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/21/2023] [Accepted: 01/16/2024] [Indexed: 01/23/2024] Open
Abstract
With the worldwide spread of SARS-CoV-2 disease, people with cystic fibrosis (CF), especially solid organ transplant recipients, have quickly been identified as a risk group for severe disease. Studies have shown low antibody response to SARS-CoV-2 vaccines in recipients of solid organ transplant compared to the healthy population. Information on immune response in CF patients with solid organ transplantation is limited, especially regarding long-term efficacy. The aim of this real-world study was a long-term assessment of humoral immune response induced by three and four doses of the SARS-CoV-2 mRNA vaccine. S1RBD and IgG antibodies were measured every 12 weeks over a period of 27 months in twelve CF patients (five liver and seven lung transplantation recipients). A total of 83.3% of our patients showed a positive antibody response after three doses of the SARS-CoV-2 mRNA vaccine. A sustained immune response was observed in both groups over the observation period, with liver transplant recipients showing higher levels than lung transplant recipients. This study is among the first to show long-term data with constantly elevated or even increasing antibody levels. We conclude that this effect is most likely associated with repeated boostering in terms of infections and booster vaccinations.
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Affiliation(s)
- Teresa Fuchs
- Department of Child and Adolescent Health, Paediatrics III, Cystic Fibrosis Centre Innsbruck, Medical University of Innsbruck, 6020 Innsbruck, Austria
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Han A, Min S, Jo EA, Lee H, Kim YC, Han SS, Kang HG, Ahn YH, Oh I, Song EY, Ha J. Association Between Low Anti-spike Antibody Levels After the Third Dose of SARS-CoV-2 Vaccination and Hospitalization due to Symptomatic Breakthrough Infection in Kidney Transplant Recipients. Ann Lab Med 2024; 44:64-73. [PMID: 37665287 PMCID: PMC10485855 DOI: 10.3343/alm.2024.44.1.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/11/2023] [Accepted: 07/26/2023] [Indexed: 09/05/2023] Open
Abstract
Background Whether anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody levels post-third coronavirus disease (COVID-19) vaccination correlate with worse outcomes due to breakthrough infection is unclear. We evaluated the association between anti-SARS-CoV-2 antibody levels and symptomatic breakthrough infection or hospitalization during the Omicron surge in kidney transplant recipients. Methods In total, 287 kidney transplant recipients expected to receive a third vaccination were enrolled between November 2021 and February 2022. The Abbott SARS-CoV-2 IgG II Quant test (Abbott, Chicago, IL, USA) was performed within three weeks before and four weeks after the third vaccination. The incidence of symptomatic breakthrough infection and hospitalization from two weeks to four months post-third vaccination was recorded. Results After the third vaccination, the seropositive rate and median antibody titer of the 287 patients increased from 57.1% to 82.2% and from 71.7 (interquartile range [IQR] 7.2-402.8) to 1,612.1 (IQR 153.9-5,489.1) AU/mL, respectively. Sixty-four (22.3%) patients had symptomatic breakthrough infections, of whom 12 required hospitalization. Lower anti-receptor-binding domain (RBD) IgG levels (<400 AU/mL) post-third vaccination were a risk factor for symptomatic breakthrough infection (hazard ratio [HR]=3.46, P<0.001). Anti-RBD IgG levels <200 AU/mL were a critical risk factor for hospitalization (HR=36.4, P=0.007). Conclusions Low anti-spike IgG levels after third vaccination in kidney transplant recipients were associated with symptomatic breakthrough infection and, particularly, with hospitalization during the Omicron surge. These data can be used to identify patients requiring additional protective measures, such as passive immunization using monoclonal antibodies.
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Affiliation(s)
- Ahram Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sangil Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Eun-Ah Jo
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Yo Han Ahn
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Inseong Oh
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Young Song
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jongwon Ha
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Naylor KL, Knoll GA, Smith G, McArthur E, Kwong JC, Dixon SN, Treleaven D, Kim SJ. Effectiveness of a Fourth COVID-19 mRNA Vaccine Dose Against the Omicron Variant in Solid Organ Transplant Recipients. Transplantation 2024; 108:294-302. [PMID: 38098159 DOI: 10.1097/tp.0000000000004766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND The effectiveness of booster doses of COVID-19 vaccines in solid organ transplant recipients is unclear. We conducted a population-based matched cohort study using linked administrative healthcare databases from Ontario, Canada to estimate the marginal vaccine effectiveness of a fourth versus third dose of the BNT162b2 and mRNA-1273 vaccines against clinically important outcomes (ie, hospitalization or death) and infection during the era of the Omicron variant. METHODS We matched 3120 solid organ transplant recipients with a third COVID-19 vaccine dose (reference) to 3120 recipients with a fourth dose. Recipients were matched on the third dose date (±7 d). We used a multivariable Cox proportional hazards model to estimate the marginal vaccine effectiveness with outcomes occurring between December 21, 2021 and April 30, 2022. RESULTS The cumulative incidence of COVID-19-related hospitalization or death was 2.8% (95% confidence interval [CI], 2.0-3.7) in the third dose group compared with 1.1% (95% CI, 0.59-1.8) in the fourth dose group after 84 d of follow-up (P < 0.001). The adjusted marginal vaccine effectiveness was 70% (95% CI, 47-83) against clinically important outcomes and 39% (95% CI, 21-52) against SARS-CoV-2 infection. CONCLUSIONS Compared with a third dose, a fourth dose of the COVID-19 vaccine was associated with improved protection against hospitalization, death, and SARS-CoV-2 infection during the Omicron era. Results highlight the importance of a booster COVID-19 vaccine dose in solid organ transplant recipients.
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Affiliation(s)
- Kyla L Naylor
- ICES, Toronto, ON, Canada
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
| | - Gregory A Knoll
- ICES, Toronto, ON, Canada
- Department of Medicine (Nephrology), University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Graham Smith
- ICES, Toronto, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
| | - Eric McArthur
- ICES, Toronto, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
| | - Jeffrey C Kwong
- ICES, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
- Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Stephanie N Dixon
- ICES, Toronto, ON, Canada
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
| | - Darin Treleaven
- Trillium Gift of Life Network, Ontario Health, Toronto, ON, Canada
- Division of Nephrology, McMaster University, Hamilton, ON, Canada
| | - S Joseph Kim
- ICES, Toronto, ON, Canada
- Division of Nephrology, University Health Network, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Watschinger C, Stampfel G, Zollner A, Hoog AM, Rössler A, Reiter S, Dax K, Kimpel J, Tilg H, Antlanger M, Schwaiger E, Moschen AR. B and T Cell Responses to SARS-CoV-2 Vaccination in Kidney and Liver Transplant Recipients with and without Previous COVID-19. Viruses 2023; 16:1. [PMID: 38275936 PMCID: PMC10820906 DOI: 10.3390/v16010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/09/2023] [Accepted: 12/14/2023] [Indexed: 01/27/2024] Open
Abstract
(1) Background: Vulnerable populations including transplant recipients are jeopardised by COVID-19. Herein, we report on B and T cell responses among liver and kidney organ recipients at our centre. (2) Methods: 23 liver and 45 kidney (14 thereof combined kidney/pancreas) transplanted patients were vaccinated with two doses of BNT162b2 followed by a booster dose of mRNA-1273 in 28 non-responders 4 months thereafter. Anti-SARS-CoV-2-Ig was measured by specific ELISA and virus neutralisation assay; T cell responses were measured by a spike protein-specific IFN-γ release assay. (3) Results: Compared to controls, B and T cell responses were weak in transplant recipients, particularly in those without prior exposure to SARS-CoV-2. Within this group, only 15% after the first and 58.3% after the second vaccination achieved seroconversion. A total of 14 out of 28 vaccination non-responders achieved a seroconversion after a third dose. Vaccination side effects were more frequent in healthy controls. The use of mycophenolate was associated with reduced anti-SARS-CoV-2-Ig production. (4) Conclusions: Our data confirm that vaccination responses are insufficient after standard vaccination in liver and kidney transplant recipients and are affected to a variable degree by specific immunosuppressants, particularly mycophenolate. Monitoring vaccination success and re-vaccinating those who are unresponsive seems prudent to achieve sufficient titres. Overall, prospective large-scale, multinational, multicentre studies or high-quality meta-analyses will be needed to generate personalised vaccination strategies in order to achieve protective immunity in high-risk, hard-to-immunize populations.
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Affiliation(s)
- Christina Watschinger
- Department of Internal Medicine 2 (Gastroenterology and Hepatology, Endocrinology and Metabolism, Nephrology, Rheumatology), Faculty of Medicine, Johannes Kepler University Linz, 4021 Linz, Austria
- Christian Doppler Laboratory for Mucosal Immunology, Faculty of Medicine, Johannes Kepler University Linz, 4021 Linz, Austria
| | - Gerald Stampfel
- Department of Internal Medicine 2 (Gastroenterology and Hepatology, Endocrinology and Metabolism, Nephrology, Rheumatology), Faculty of Medicine, Johannes Kepler University Linz, 4021 Linz, Austria
| | - Andreas Zollner
- Christian Doppler Laboratory for Mucosal Immunology, Faculty of Medicine, Johannes Kepler University Linz, 4021 Linz, Austria
- Department of Medicine, Division of Internal Medicine 1 (Gastroenterology and Hepatology, Endocrinology and Metabolism), Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Anna M. Hoog
- Department of Internal Medicine 2 (Gastroenterology and Hepatology, Endocrinology and Metabolism, Nephrology, Rheumatology), Faculty of Medicine, Johannes Kepler University Linz, 4021 Linz, Austria
- Christian Doppler Laboratory for Mucosal Immunology, Faculty of Medicine, Johannes Kepler University Linz, 4021 Linz, Austria
| | - Annika Rössler
- Department of Hygiene, Microbiology, and Public Health, Institute of Virology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Silvia Reiter
- Department of Internal Medicine 2 (Gastroenterology and Hepatology, Endocrinology and Metabolism, Nephrology, Rheumatology), Faculty of Medicine, Johannes Kepler University Linz, 4021 Linz, Austria
| | - Kristina Dax
- Department of Internal Medicine 2 (Gastroenterology and Hepatology, Endocrinology and Metabolism, Nephrology, Rheumatology), Faculty of Medicine, Johannes Kepler University Linz, 4021 Linz, Austria
| | - Janine Kimpel
- Department of Hygiene, Microbiology, and Public Health, Institute of Virology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Herbert Tilg
- Department of Medicine, Division of Internal Medicine 1 (Gastroenterology and Hepatology, Endocrinology and Metabolism), Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Marlies Antlanger
- Department of Internal Medicine 2 (Gastroenterology and Hepatology, Endocrinology and Metabolism, Nephrology, Rheumatology), Faculty of Medicine, Johannes Kepler University Linz, 4021 Linz, Austria
| | - Elisabeth Schwaiger
- Department of Internal Medicine 2 (Gastroenterology and Hepatology, Endocrinology and Metabolism, Nephrology, Rheumatology), Faculty of Medicine, Johannes Kepler University Linz, 4021 Linz, Austria
- Department of Internal Medicine, Brothers of Saint John of God Eisenstadt, 7000 Eisenstadt, Austria
| | - Alexander R. Moschen
- Department of Internal Medicine 2 (Gastroenterology and Hepatology, Endocrinology and Metabolism, Nephrology, Rheumatology), Faculty of Medicine, Johannes Kepler University Linz, 4021 Linz, Austria
- Christian Doppler Laboratory for Mucosal Immunology, Faculty of Medicine, Johannes Kepler University Linz, 4021 Linz, Austria
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9
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Kijak GH, Ahani B, Arbetter D, Chuecos F, Gopalakrishnan V, Beloor J, Brady T, Nguyen A, Roe TL, Schuko N, Zhang T, Hobbs FDR, Padilla F, Kelly EJ, Montgomery H, Streicher K. Analysis of SARS-CoV-2 Emergent Variants Following AZD7442 (Tixagevimab/Cilgavimab) for Early Outpatient Treatment of COVID-19 (TACKLE Trial). Infect Dis Ther 2023; 12:2691-2707. [PMID: 37914983 PMCID: PMC10746613 DOI: 10.1007/s40121-023-00882-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/25/2023] [Indexed: 11/03/2023] Open
Abstract
INTRODUCTION AZD7442 (tixagevimab/cilgavimab) comprises neutralising monoclonal antibodies (mAbs) that bind to distinct non-overlapping epitopes on the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein. Viral evolution during mAb therapy can select for variants with reduced neutralisation susceptibility. We examined treatment-emergent SARS-CoV-2 variants during TACKLE (NCT04723394), a phase 3 study of AZD7442 for early outpatient treatment of coronavirus disease 2019 (COVID-19). METHODS Non-hospitalised adults with mild-to-moderate COVID-19 were randomised and dosed ≤ 7 days from symptom onset with AZD7442 (n = 452) or placebo (n = 451). Next-generation sequencing of the spike gene was performed on SARS-CoV-2 reverse-transcription polymerase chain reaction-positive nasopharyngeal swabs at baseline and study days 3, 6, and 15 post dosing. SARS-CoV-2 lineages were assigned using spike nucleotide sequences. Amino acid substitutions were analysed at allele fractions (AF; % of sequence reads represented by substitution) ≥ 25% and 3% to 25%. In vitro susceptibility to tixagevimab, cilgavimab, and AZD7442 was evaluated for all identified treatment-emergent variants using a pseudotyped microneutralisation assay. RESULTS Longitudinal spike sequences were available for 461 participants (AZD7442, n = 235; placebo, n = 226) and showed that treatment-emergent variants at any time were rare, with 5 (2.1%) AZD7442 participants presenting ≥ 1 substitution in tixagevimab/cilgavimab binding sites at AF ≥ 25%. At AF 3% to 25%, treatment-emergent variants were observed in 15 (6.4%) AZD7442 and 12 (5.3%) placebo participants. All treatment-emergent variants showed in vitro susceptibility to AZD7442. CONCLUSION These data indicate that AZD7442 creates a high genetic barrier for resistance and is a feasible option for COVID-19 treatment.
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Affiliation(s)
- Gustavo H Kijak
- Translational Medicine, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA.
| | - Bahar Ahani
- Bioinformatics, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Douglas Arbetter
- Biometrics, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Boston, MA, USA
| | - Fernando Chuecos
- Biometrics, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Barcelona, Spain
| | | | - Jagadish Beloor
- Translational Medicine, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Tyler Brady
- Translational Medicine, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Amy Nguyen
- Translational Medicine, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Tiffany L Roe
- Translational Medicine, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Nicolette Schuko
- Translational Medicine, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Tianhui Zhang
- Formerly Data Sciences and Quantitative Biology, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Francisco Padilla
- Centro de Investigación en Cardiología y Metabolismo, Guadalajara, Jalisco, Mexico
| | - Elizabeth J Kelly
- Formerly Translational Medicine, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Hugh Montgomery
- Department of Medicine, University College London, London, UK
| | - Katie Streicher
- Translational Medicine, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
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10
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Yu B, Tamargo C, Brennan DC, Kant S. Measures to Increase Immunogenicity of SARS-CoV-2 Vaccines in Solid Organ Transplant Recipients: A Narrative Review. Vaccines (Basel) 2023; 11:1755. [PMID: 38140160 PMCID: PMC10748337 DOI: 10.3390/vaccines11121755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/17/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023] Open
Abstract
Purpose of review: To review the data on the immunogenicity of COVID-19 vaccines, administered by different strategies, in solid organ transplant recipients (SOTRs). Recent findings: COVID-19 booster vaccines were given to SOTRs as a widespread practice in many transplant centers, mostly as the third and/or fourth dose in an extended vaccine series, with a significantly improved humoral response compared with the initial two-dose scheme. However, one-third of SOTRs remained unresponsive, despite these boosters. Next steps: Vaccination with standard dosing remains the most feasible strategy for attaining protection against COVID-19. Additional booster doses and temporarily holding or reducing mycophenolate mofetil/mycophenolic acid may provide immunogenicity to vaccines, according to recent studies demonstrating some efficacy with these measures. Preexposure prophylaxis with monoclonal antibodies showed benefit in immunocompromised patients but is no longer recommended by the National Institutes of Health (NIH) due to diminished efficacy against Omicron and recent variants. Screening for the presence and titers of SARS-CoV-2-specific antibodies in SOTRs is not recommended in most clinical settings. T cell-based techniques are needed to evaluate vaccine efficacy and risk of infection. As SARS-CoV-2 continues to evolve, new vaccines based on conservative protein component/complexes of the COVID virus, in addition to its spike protein, are warranted to offer prolonged protection.
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Affiliation(s)
- Bo Yu
- Department of Medicine, University of Maryland Medical Center, Midtown Campus, Baltimore, MD 21201, USA;
| | - Christina Tamargo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
| | - Daniel C. Brennan
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
- Comprehensive Transplant Center, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Sam Kant
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
- Comprehensive Transplant Center, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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11
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Kugler S, Vári DK, Veres DS, Király Á, Teszák T, Parázs N, Tarjányi Z, Drobni Z, Szakál‐Tóth Z, Prinz G, Miheller P, Merkely B, Sax B. Seroconversion after SARS-CoV-2 vaccination is protective against severe COVID-19 disease in heart transplant recipients. Immun Inflamm Dis 2023; 11:e1086. [PMID: 38018598 PMCID: PMC10652352 DOI: 10.1002/iid3.1086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 10/15/2023] [Accepted: 11/02/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Heart transplant (HTX) recipients are prone to develop complications after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Vaccination is often ineffective due to weaker immunogenicity. In this high-volume single-center study, we aimed to determine factors influencing seroconversion after vaccination and predictors of severe SARS-CoV-2 infection. METHODS Two hundred twenty-nine HTX recipients were enrolled. Type of the first two vaccine doses included messenger RNA (mRNA), vector, and inactivated vaccines. We carried out analyses on seroconversion after the second and third doses of vaccination and on severity of infection. Antispike protein SARS-CoV-2 immunoglobulin G (IgG) was measured after the second and third vaccines and serostatus was defined. Effect of the first two vaccine doses was studied on patients who did not suffer SARS-CoV-2 infection before antibody measurement (n = 175). The effectivity of the third vaccine was evaluated among seronegative recipients after the second vaccine (n = 53). Predictors for severe infection defined as pneumonia, hospitalization or death were assessed in all patients who contracted SARS-CoV-2 infection (n = 92). RESULTS 62% of the recipients became seropositive after the second vaccination. Longer time between HTX and vaccination (odds ratio [OR]: 2.35) and mRNA vaccine (OR: 4.83) were predictors of seroconversion. 58% of the nonresponsive patients became seropositive after receiving the third vaccine. Male sex increased the chance of IgG production after the third dose (OR: 5.65). Clinical course of SARS-CoV-2 infection was severe in 32%. Of all parameters assessed, only seropositivity before infection was proven to have a protective effect against severe infection (OR: 0.11). CONCLUSIONS We found that longer time since HTX, mRNA vaccine type, and male sex promoted seroconversion after SARS-CoV-2 vaccination in HTX recipients. Seropositivity-but not the number of vaccine doses-seemed to be protective against severe SARS-CoV-2 infection. Screening of HTX patients for anti-SARS-COV-2 antibodies may help to identify patients at risk for severe infection.
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Affiliation(s)
- Szilvia Kugler
- Department of Cardiology, Heart and Vascular CenterSemmelweis UniversityBudapestHungary
| | | | - Dániel Sándor Veres
- Department of Biophysics and Radiation BiologySemmelweis UniversityBudapestHungary
| | - Ákos Király
- Department of Cardiology, Heart and Vascular CenterSemmelweis UniversityBudapestHungary
| | - Tímea Teszák
- Department of Cardiology, Heart and Vascular CenterSemmelweis UniversityBudapestHungary
| | - Nóra Parázs
- Department of Cardiology, Heart and Vascular CenterSemmelweis UniversityBudapestHungary
| | - Zoltán Tarjányi
- Department of Cardiology, Heart and Vascular CenterSemmelweis UniversityBudapestHungary
| | - Zsófia Drobni
- Department of Cardiology, Heart and Vascular CenterSemmelweis UniversityBudapestHungary
| | - Zsófia Szakál‐Tóth
- Department of Cardiology, Heart and Vascular CenterSemmelweis UniversityBudapestHungary
| | - Gyula Prinz
- Department of Cardiology, Heart and Vascular CenterSemmelweis UniversityBudapestHungary
| | - Pál Miheller
- Department of Surgery, Transplantation and GastroenterologySemmelweis UniversityBudapestHungary
| | - Béla Merkely
- Department of Cardiology, Heart and Vascular CenterSemmelweis UniversityBudapestHungary
| | - Balázs Sax
- Department of Cardiology, Heart and Vascular CenterSemmelweis UniversityBudapestHungary
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12
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Fylaktou A, Stai S, Kasimatis E, Xochelli A, Nikolaidou V, Papadopoulou A, Myserlis G, Lioulios G, Asouchidou D, Giannaki M, Yannaki E, Tsoulfas G, Papagianni A, Stangou M. Humoral and Cellular Immunity Are Significantly Affected in Renal Transplant Recipients, following Vaccination with BNT162b2. Vaccines (Basel) 2023; 11:1670. [PMID: 38006002 PMCID: PMC10674678 DOI: 10.3390/vaccines11111670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Renal transplant recipients (RTRs) tend to mount weaker immune responses to vaccinations, including vaccines against the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS Humoral immunity was assessed using anti-receptor binding domain (RBD) and neutralizing antibodies (NAb) serum levels measured by ELISA, and cellular immunity was assessed using T-, B-, NK, natural killer-like T (NKT)-cell subpopulations, and monocytes measured by flow cytometry, and also specific T-cell immunity, at predefined time points after BNT162b2 vaccination, in 57 adult RTRs. RESULTS Administration of three booster doses was necessary to achieve anti-RBD and NAb protective levels in almost all patients (92.98%). Ab production, at several time points, was positively correlated with the corresponding renal function and inversely correlated with hemodialysis vintage (HDV) and treatment with mycophenolic acid (MPA). A gradual rise in several cell subpopulations, including total lymphocytes (p = 0.026), memory B cells (p = 0.028), activated CD4 (p = 0.005), and CD8 cells (p = 0.001), was observed even after the third vaccination dose, while a significant reduction in CD3+PD1+ (p = 0.002), NKT (p = 0.011), and activated NKT cells (p = 0.034) was noted during the same time interval. Moreover, SARS-CoV-2-specific T-cells were present in 41% of the patients who were unable to develop Nabs, and their positivity rates four months after the second dose were in inverse correlation with monocytes (p = 0.045) and NKT cells (p = 0.01). CONCLUSIONS SARS-CoV-2-specific T-cell responses preceded the humoral ones, while two booster doses were needed for this group of immunocompromised patients to mount a protective immune response.
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Affiliation(s)
- Asimina Fylaktou
- Department of Immunology, National Histocompatibility Center, Hippokration General Hospital, 54642 Thessaloniki, Greece; (A.F.); (A.X.); (V.N.); (D.A.)
| | - Stamatia Stai
- Department of Nephrology, Hippokration Hospital, 54642 Thessaloniki, Greece; (S.S.); (E.K.); (G.L.); (A.P.)
- School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Efstratios Kasimatis
- Department of Nephrology, Hippokration Hospital, 54642 Thessaloniki, Greece; (S.S.); (E.K.); (G.L.); (A.P.)
| | - Aliki Xochelli
- Department of Immunology, National Histocompatibility Center, Hippokration General Hospital, 54642 Thessaloniki, Greece; (A.F.); (A.X.); (V.N.); (D.A.)
| | - Vasiliki Nikolaidou
- Department of Immunology, National Histocompatibility Center, Hippokration General Hospital, 54642 Thessaloniki, Greece; (A.F.); (A.X.); (V.N.); (D.A.)
| | - Anastasia Papadopoulou
- Hematology Department-Hematopoietic Cell Transplantation Unit, Gene and Cell Therapy Center, “George Papanikolaou” Hospital, 57010 Thessaloniki, Greece; (A.P.); (M.G.); (E.Y.)
| | - Grigorios Myserlis
- Department of Transplant Surgery, Hippokration Hospital, 54642 Thessaloniki, Greece;
| | - Georgios Lioulios
- Department of Nephrology, Hippokration Hospital, 54642 Thessaloniki, Greece; (S.S.); (E.K.); (G.L.); (A.P.)
- School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Despoina Asouchidou
- Department of Immunology, National Histocompatibility Center, Hippokration General Hospital, 54642 Thessaloniki, Greece; (A.F.); (A.X.); (V.N.); (D.A.)
| | - Maria Giannaki
- Hematology Department-Hematopoietic Cell Transplantation Unit, Gene and Cell Therapy Center, “George Papanikolaou” Hospital, 57010 Thessaloniki, Greece; (A.P.); (M.G.); (E.Y.)
| | - Evangelia Yannaki
- Hematology Department-Hematopoietic Cell Transplantation Unit, Gene and Cell Therapy Center, “George Papanikolaou” Hospital, 57010 Thessaloniki, Greece; (A.P.); (M.G.); (E.Y.)
| | - Georgios Tsoulfas
- School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
- Department of Transplant Surgery, Hippokration Hospital, 54642 Thessaloniki, Greece;
| | - Aikaterini Papagianni
- Department of Nephrology, Hippokration Hospital, 54642 Thessaloniki, Greece; (S.S.); (E.K.); (G.L.); (A.P.)
- School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Maria Stangou
- Department of Nephrology, Hippokration Hospital, 54642 Thessaloniki, Greece; (S.S.); (E.K.); (G.L.); (A.P.)
- School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
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13
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Sanayei AM, Montalvan A, Faria I, Ochalla J, Pavlakis M, Blair BM, Alonso CD, Curry M, Saberi B. Tixagevimab-Cilgavimab Decreases the Rate of SARS-CoV-2 Infection Among Solid Organ Transplant Recipients. Transplant Proc 2023; 55:1784-1792. [PMID: 37661468 DOI: 10.1016/j.transproceed.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/06/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND SARS-CoV-2 infection in solid organ transplant (SOT) recipients is associated with high morbidity and mortality. Tixagevimab/cilgavimab monoclonal antibodies were previously authorized for pre-exposure prophylaxis for immunocompromised individuals. We aimed to determine if tixagevimab/cilgavimab could prevent breakthrough SARS-CoV-2 infection in SOT recipients. MATERIAL AND METHODS We conducted a prospective single-center study of SOT recipients who received tixagevimab/cilgavimab compared with those who did not. Demographics, type of transplant, immunosuppression regimen, COVID-19 vaccination status, and tixagevimab/cilgavimab administration data were collected. Participants were interviewed for 6 months or until they tested positive for SARS-CoV-2, whichever came first. Kaplan-Meier SARS-CoV-2-free survival curves were created based on the tixagevimab/cilgavimab administration date and SARS-CoV-2 infection. The log-rank test was used for comparison. Univariate and multivariate Cox regression models were constructed. RESULTS The study cohort included 323 patients. Two hundred forty-eight received tixagevimab/cilgavimab, and 75 did not (control). COVID-19 vaccination rate was higher among tixagevimab/cilgavimab recipients than nontixagevimab/cilgavimab recipients (99.6% vs 92.0%; P < .001). Twenty-six patients in the tixagevimab/cilgavimab group (10.5%) and 23 in the control group (30.7%) tested positive for SARS-CoV-2 infection (P < .001). In a multivariate analysis, receipt of tixagevimab/cilgavimab and duration from transplant were both associated with reduced risk of SARS-CoV-2 infection (hazard ratio 0.431; 95% CI 0.224-0.828 and hazard ratio 0.917; 95% CI 0.861-0.978, respectively). CONCLUSION During the study period, SOT recipients who received tixagevimab/cilgavimab had a significantly lower rate of SARS-CoV-2 infection. There were no differences in symptom frequency, illness severity, hospitalization rate, or treatment of SARS-CoV-2 infection.
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Affiliation(s)
- Ava M Sanayei
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Adriana Montalvan
- Division of Transplant Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Isabella Faria
- Division of Transplant Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Julia Ochalla
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Martha Pavlakis
- Division of Nephrology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Barbra M Blair
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Carolyn D Alonso
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Michael Curry
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Behnam Saberi
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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14
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Meejun T, Srisurapanont K, Manothummetha K, Thongkam A, Mejun N, Chuleerarux N, Sanguankeo A, Phongkhun K, Leksuwankun S, Thanakitcharu J, Lerttiendamrong B, Langsiri N, Torvorapanit P, Worasilchai N, Plongla R, Hirankarn N, Nematollahi S, Permpalung N, Moonla C, Kates OS. Attenuated immunogenicity of SARS-CoV-2 vaccines and risk factors in stem cell transplant recipients: a meta-analysis. Blood Adv 2023; 7:5624-5636. [PMID: 37389818 PMCID: PMC10514108 DOI: 10.1182/bloodadvances.2023010349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/05/2023] [Accepted: 06/25/2023] [Indexed: 07/01/2023] Open
Abstract
Immunogenicity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination is diminished in hematopoietic stem cell transplant (HSCT) recipients. To summarize current evidence and identify risk factors for attenuated responses, 5 electronic databases were searched since database inceptions through 12 January 2023 for studies reporting humoral and/or cellular immunogenicity of SARS-CoV-2 vaccination in the HSCT population. Using descriptive statistics and random-effects models, extracted numbers of responders and pooled odds ratios (pORs) with 95% confidence intervals (CIs) for risk factors of negative immune responses were analyzed (PROSPERO: CRD42021277109). From 61 studies with 5906 HSCT recipients, after 1, 2, and 3 doses of messenger RNA (mRNA) SARS-CoV-2 vaccines, the mean antispike antibody seropositivity rates (95% CI) were 38% (19-62), 81% (77-84), and 80% (75-84); neutralizing antibody seropositivity rates were 52% (40-64), 71% (54-83), and 78% (61-89); and cellular immune response rates were 52% (39-64), 66% (51-79), and 72% (52-86). After 2 vaccine doses, risk factors (pOR; 95% CI) associated with antispike seronegativity were male recipients (0.63; 0.49-0.83), recent rituximab exposure (0.09; 0.03-0.21), haploidentical allografts (0.46; 0.22-0.95), <24 months from HSCT (0.25; 0.07-0.89), lymphopenia (0.18; 0.13-0.24), hypogammaglobulinemia (0.23; 0.10-0.55), concomitant chemotherapy (0.48; 0.29-0.78) and immunosuppression (0.18; 0.13-0.25). Complete remission of underlying hematologic malignancy (2.55; 1.05-6.17) and myeloablative conditioning (1.72; 1.30-2.28) compared with reduced-intensity conditioning were associated with antispike seropositivity. Ongoing immunosuppression (0.31; 0.10-0.99) was associated with poor cellular immunogenicity. In conclusion, attenuated humoral and cellular immune responses to mRNA SARS-CoV-2 vaccination are associated with several risk factors among HSCT recipients. Optimizing individualized vaccination and developing alternative COVID-19 prevention strategies are warranted.
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Affiliation(s)
- Tanaporn Meejun
- Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Kasama Manothummetha
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Achitpol Thongkam
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nuthchaya Mejun
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nipat Chuleerarux
- Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL
| | - Anawin Sanguankeo
- Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kasidis Phongkhun
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Surachai Leksuwankun
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | | | - Nattapong Langsiri
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pattama Torvorapanit
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Thai Red Cross Emerging Infectious Diseases Clinical Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - Rongpong Plongla
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Nattiya Hirankarn
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Saman Nematollahi
- Department of Medicine, University of Arizona College of Medicine, Tucson, AZ
| | - Nitipong Permpalung
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Chatphatai Moonla
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center of Excellence in Translational Hematology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Olivia S. Kates
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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15
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Liew MY, Mathews JI, Li A, Singh R, Jaramillo SA, Weiss ZF, Bowman K, Ankomah PO, Ghantous F, Lewis GD, Neuringer I, Bitar N, Lipiner T, Dighe AS, Kotton CN, Seaman MS, Lemieux JE, Goldberg MB. Delayed and Attenuated Antibody Responses to Coronavirus Disease 2019 Vaccination With Poor Cross-Variant Neutralization in Solid-Organ Transplant Recipients-A Prospective Longitudinal Study. Open Forum Infect Dis 2023; 10:ofad369. [PMID: 37577118 PMCID: PMC10414143 DOI: 10.1093/ofid/ofad369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Background Therapeutically immunosuppressed transplant recipients exhibit attenuated responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines. To elucidate the kinetics and variant cross-protection of vaccine-induced antibodies in this population, we conducted a prospective longitudinal study in heart and lung transplant recipients receiving the SARS-CoV-2 messenger RNA (mRNA) 3-dose vaccination series. Methods We measured longitudinal serum antibody and neutralization responses against the ancestral and major variants of SARS-CoV-2 in SARS-CoV-2-uninfected lung (n = 18) and heart (n = 17) transplant recipients, non-lung-transplanted patients with cystic fibrosis (n = 7), and healthy controls (n = 12) before, during, and after the primary mRNA vaccination series. Results Among healthy controls, strong anti-spike responses arose immediately following vaccination and displayed cross-neutralization against all variants. In contrast, among transplant recipients, after the first 2 vaccine doses, increases in antibody concentrations occurred gradually, and cross-neutralization was completely absent against the Omicron B.1.1.529 variant. However, most (73%) of the transplant recipients had a significant response to the third vaccine dose, reaching levels comparable to those of healthy controls, with improved but attenuated neutralization of immune evasive variants, particularly Beta, Gamma, and Omicron. Responses in non-lung-transplanted patients with cystic fibrosis paralleled those in healthy controls. Conclusions In this prospective, longitudinal analysis of variant-specific antibody responses, lung and heart transplant recipients display delayed and defective responses to the first 2 SARS-CoV-2 vaccine doses but significantly augmented responses to a third dose. Gaps in antibody-mediated immunity among transplant recipients are compounded by decreased neutralization against Omicron variants, leaving many patients with substantially weakened immunity against currently circulating variants.
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Affiliation(s)
- May Y Liew
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Josh I Mathews
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amy Li
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Rohan Singh
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Salvador A Jaramillo
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Zoe F Weiss
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kathryn Bowman
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Pierre O Ankomah
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Fadi Ghantous
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Gregory D Lewis
- Heart Transplant Program, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Isabel Neuringer
- Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Natasha Bitar
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Taryn Lipiner
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anand S Dighe
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Camille N Kotton
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael S Seaman
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jacob E Lemieux
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Infectious Disease and Microbiome Program, The Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, Massachusetts, USA
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Marcia B Goldberg
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Infectious Disease and Microbiome Program, The Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, Massachusetts, USA
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA
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16
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Udomkarnjananun S, Gatechompol S, Leelahavanichkul A, Kerr SJ. Cellular immune response of SARS-CoV-2 vaccination in kidney transplant recipients: a systematic review and meta-analysis. Front Immunol 2023; 14:1220148. [PMID: 37575225 PMCID: PMC10415203 DOI: 10.3389/fimmu.2023.1220148] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/05/2023] [Indexed: 08/15/2023] Open
Abstract
Background Evidence has demonstrated inferior humoral immune responses after SARS-CoV-2 vaccination in kidney transplant recipients compared to the general population. However, data on cellular immune responses in this population have not been established. Methods We searched the MEDLINE, Scopus, and Cochrane databases and included studies reporting cellular immune response rates in kidney transplant recipients after receiving SARS-CoV-2 vaccines. Studies that reported factors associated with cellular immune responders or non-responders were also included (PROSPERO: CRD42022375544). Results From a total of 1,494 articles searched, 53 articles were included in the meta-analysis. In all, 21 studies assessed cellular immune response by interferon-γ enzyme-linked immunosorbent spot (IFN-γ ELISPOT), 22 studies used interferon-γ release assay (IGRA), and 10 studies used flow cytometric analysis. The pooled response rate after two doses (standard regimen) and three doses of vaccination was 47.5% (95%CI 38.4-56.7%) and 69.1% (95%CI 56.3-80.6%) from IFN-γ ELISPOT, 25.8% (95%CI 19.7-32.4%) and 14.7% (95%CI 8.5-22.2%) from IGRA, and 73.7% (95%CI 55.2-88.8%) and 86.5% (95%CI 75.3-94.9%) from flow cytometry, respectively. Recipients with seroconversion were associated with a higher chance of having cellular immune response (OR 2.58; 95%CI 1.89-3.54). Cellular immune response in kidney transplant recipients was lower than in dialysis patients (OR 0.24; 95%CI 0.16-0.34) and the general population (OR 0.10; 95%CI 0.07-0.14). Age and immunosuppressants containing tacrolimus or corticosteroid were associated with inferior cellular immune response. Conclusion Cellular immune response after SARS-CoV-2 vaccination in kidney transplant recipients was lower than in dialysis patients and the general population. Age, tacrolimus, and corticosteroid were associated with poor response. Cellular immune response should also be prioritized in vaccination studies. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42022375544.
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Affiliation(s)
- Suwasin Udomkarnjananun
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Excellence Center for Organ Transplantation (ECOT), King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Renal Immunology and Transplantation Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Asada Leelahavanichkul
- Center of Excellence on Translational Research in Inflammation and Immunology (CETRII), Department of Microbiology, Chulalongkorn University, Bangkok, Thailand
- Immunology Unit, Department of Microbiology, Chulalongkorn University, Bangkok, Thailand
| | - Stephen J. Kerr
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Biostatistics Excellence Centre, Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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17
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Kim ST, Iyengar A, Helmers MR, Weingarten N, Rekhtman D, Song C, Shin M, Cevasco M, Atluri P. Outcomes of COVID-19-Positive Donor Heart Transplantation in the United States. J Am Heart Assoc 2023:e029178. [PMID: 37421286 PMCID: PMC10382108 DOI: 10.1161/jaha.122.029178] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/30/2023] [Indexed: 07/10/2023]
Abstract
Background Little is known regarding the impact of donor COVID-19 status on recipient outcomes after heart transplantation. In this study, we characterize outcomes of the first 110 heart transplants from organ donors positive for COVID-19 (COVID-19+) in the United States. Methods and Results Retrospective analysis of the United Network for Organ Sharing database was performed for single-organ adult heart transplants from January 2020 to March 2022. Donor COVID-19+ status was defined as a positive nucleic acid amplification, antigen, or other COVID-19 test within 7 days of transplant. Nearest-neighbor propensity score matching used to adjust for differences between recipients of COVID-19+ and nonpositive donor hearts. Overall, 7251 heart transplants were included in analysis, with 110 using COVID-19+ donor hearts. Recipients of COVID-19+ allografts were younger (54 [interquartile range, 41-61]) versus 57 [46-64] years; P=0.02) but had similar rates of female sex and non-White race compared with those receiving allografts from negative donors. Nearest-neighbor propensity score matching resulted in 100 well-matched pairs of recipients of COVID-19+ versus nonpositive donor organs. The 2 matched groups had similar median lengths of stay (15 [11-23] days versus 15 [13-23] days; P=0.40), rates of graft failure (1% versus 0%; P=0.99), 30-day death (3% versus 3%; P=0.99), and 3-month survival (88% versus 94%; P=0.23) compared with recipients of nonpositive donors. No deaths occurred due to COVID-19 infection among the 8 (7%) total deceased recipients of COVID-19+ allografts to date. Conclusions Short-term outcomes of heart transplant recipients receiving COVID-19+ donor organs are reassuring. However, continued monitoring for long-term survival and potential complications are warranted.
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Affiliation(s)
- Samuel T Kim
- David Geffen School of Medicine University of California Los Angeles CA USA
| | - Amit Iyengar
- Division of Cardiovascular Surgery University of Pennsylvania Philadelphia PA USA
| | - Mark R Helmers
- Division of Cardiovascular Surgery University of Pennsylvania Philadelphia PA USA
| | - Noah Weingarten
- Division of Cardiovascular Surgery University of Pennsylvania Philadelphia PA USA
| | - David Rekhtman
- Division of Cardiovascular Surgery University of Pennsylvania Philadelphia PA USA
| | - Cindy Song
- Division of Cardiovascular Surgery University of Pennsylvania Philadelphia PA USA
| | - Max Shin
- Division of Cardiovascular Surgery University of Pennsylvania Philadelphia PA USA
| | - Marisa Cevasco
- Division of Cardiovascular Surgery University of Pennsylvania Philadelphia PA USA
| | - Pavan Atluri
- Division of Cardiovascular Surgery University of Pennsylvania Philadelphia PA USA
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18
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Aida N, Ito T, Kurihara K, Hiratsuka I, Shibata M, Suzuki A, Hasegawa M, Kenmochi T. Impact of B Cell Depletion on COVID-19 in Kidney Transplant Recipients. Viruses 2023; 15:1520. [PMID: 37515206 PMCID: PMC10385485 DOI: 10.3390/v15071520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023] Open
Abstract
Kidney transplant recipients are patients at high risk for coronavirus disease 2019 (COVID-19) due to being on immunosuppressive therapy. B cell depletion therapy, including rituximab, is an important strategy for ABO-incompatible transplants. However, knowledge about the effect of B cell depletion therapy on COVID-19 is lacking. Thirty kidney transplant recipients who developed COVID-19 were included in this study. To examine the impact of B cell depletion therapy, we retrospectively investigated the relationship between the background of the patients and the clinical outcome. Of the 30 patients, 13 received B cell depletion therapy. The median time between transplant and onset of COVID-19 was 6.1 years after transplantation; however, nine cases remained markedly depleted of CD19(+) cells (<4.0%). The patients were assigned to the normal (n = 21) and depletion groups (n = 9). Progression rates in the depletion and normal groups were 55.6% and 9.5%, respectively (p = 0.014). Furthermore, the survival rate was significantly lower in the depletion group (100% in the normal group vs. 66.7% in the depletion group; p = 0.021). B cell depletion therapy may have long-term effects and increase the risk of COVID-19 in kidney transplant recipients.
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Affiliation(s)
- Naohiro Aida
- Department of Transplantation and Regenerative Medicine, School of Medicine, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Aichi, Japan
| | - Taihei Ito
- Department of Transplantation and Regenerative Medicine, School of Medicine, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Aichi, Japan
| | - Kei Kurihara
- Department of Transplantation and Regenerative Medicine, School of Medicine, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Aichi, Japan
| | - Izumi Hiratsuka
- Department of Endocrinology, Diabetes, and Metabolism, School of Medicine, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Aichi, Japan
| | - Megumi Shibata
- Department of Endocrinology, Diabetes, and Metabolism, School of Medicine, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Aichi, Japan
| | - Atsushi Suzuki
- Department of Endocrinology, Diabetes, and Metabolism, School of Medicine, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Aichi, Japan
| | - Midori Hasegawa
- Department of Nephrology, School of Medicine, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Aichi, Japan
| | - Takashi Kenmochi
- Department of Transplantation and Regenerative Medicine, School of Medicine, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Aichi, Japan
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19
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Mu Y, Wu H, Jiang Z, Liu K, Xue X, Zhang W, Chen Z. Serological Responses after a Fourth Dose of SARS-CoV-2 Vaccine in Solid Organ Transplant Recipients: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2023; 11:1130. [PMID: 37514946 PMCID: PMC10385971 DOI: 10.3390/vaccines11071130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023] Open
Abstract
The humoral immune response and safety of the fourth dose of the coronavirus disease 2019 (COVID-19) vaccine in solid organ transplant (SOT) recipients need to be fully elucidated. We conducted a systematic review and meta-analysis to assess the efficacy and safety associated with this additional dose of the COVID-19 vaccine in the SOT recipients. A comprehensive search was conducted to identify studies on SOT patients without prior natural SARS-CoV-2 infection who received the fourth dose of the COVID-19 vaccine. Serological antibody responses following vaccination were synthesized by a meta-analysis of proportions. The proportions for each outcome were integrated by using a random-effects model. Approximately 56-92% of the SOT patients developed a humoral immune response, and the pooled seroprevalence rate was 75% (95% confidence interval [CI], 62-82%) after administering the third vaccine dose. Following the fourth dose of vaccination, approximately 76-95% of the patients developed a humoral immune response. The pooled seroprevalence rate after the fourth dose was 85% (95% CI, 79-91%). Of the patients who initially tested seronegative after the second dose, approximately 22-76% of patients subsequently became seropositive after the third dose. The pooled seroconversion rate for the third dose was 47% (95% CI, 31-64%). Among the patients who were seronegative after the third dose, approximately 25-76% turned seropositive after the fourth dose. The pooled seroconversion rate after the fourth dose was 51% (95% CI, 40-63%). Safety data were reported in three studies, demonstrating that adverse effects following the fourth dose were generally mild, and patients with these adverse effects did not require hospitalization. No transplant rejection or serious adverse events were observed. A fourth dose of the COVID-19 vaccine in SOT recipients was associated with an improved humoral immune response, and the vaccine was considered relatively safe.
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Affiliation(s)
- Yameng Mu
- Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing 100102, China
| | - Hongxiao Wu
- Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing 100102, China
| | - Zhouling Jiang
- Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing 100102, China
| | - Kehang Liu
- Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing 100102, China
| | - Xiaoyu Xue
- Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing 100102, China
| | - Wei Zhang
- Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing 100102, China
| | - Zhihai Chen
- Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing 100102, China
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20
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van Gemert J, Steenberg F, van Leer-Buter C, Kerstjens H, Steenhuis W, Akkerman O, Verschuuren E, Gan T. Increasing Antibody Responses to Five Doses of SARS-CoV-2 mRNA Vaccine in Lung Transplant Patients. J Clin Med 2023; 12:4125. [PMID: 37373817 PMCID: PMC10299568 DOI: 10.3390/jcm12124125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/10/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
PURPOSE COVID-19 causes high mortality in Lung Transplant (LTx) patients, therefore vaccination in this population is potentially life-saving. However, the antibody response is impaired after three vaccinations in LTx patients. We questioned whether this response might be increased, and therefore studied the serological IgG antibody response across up to five doses of the SARS-CoV-2 vaccine. In addition, risk factors for non-response were investigated. METHODS In this large retrospective cohort study, antibody responses were assessed after 1-5 mRNA-based SARS-CoV-2 vaccines in all LTx patients between February 2021 and September 2022. A positive vaccine response was defined as an IgG level ≥ 300 BAU/mL. Positive antibody responses due to COVID-19 infection were excluded from the analysis. Outcome and clinical parameters were compared between responders and non-responders, and multivariable logistic regression analysis was performed to determine the risk factors for vaccine-response failure. RESULTS The antibody responses of 292 LTx patients were analyzed. Positive antibody response to 1-5 SARS-CoV-2 vaccinations occurred in 0%, 15%, 36%, 46%, and 51%, respectively. During the study period, 146/292 (50%) of the vaccinated individuals tested positive for SARS-CoV-2 infection. The COVID-19-related mortality was 2.7% (4/146), and all four patients were non-responders. Risk factors associated with non-response to SARS-CoV-2 vaccines in univariable analyses were age (p = 0.004), chronic kidney disease (CKD) (p = 0.006), and shorter time since transplantation (p = 0.047). In the multivariable analysis, they were CKD (p = 0.043), and shorter time since transplantation (p = 0.028). CONCLUSION A two- to five-dose regime of SARS-CoV-2 vaccines in LTx patients increases the probability of vaccine response and results in a cumulative vaccine response in 51% of the LTx population. LTx patient antibody response to SARS-CoV-2 vaccinations is therefore impaired, especially in patients shortly after LTx, patients with CKD, and the elderly.
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Affiliation(s)
- Johanna van Gemert
- Department of Pulmonary Diseases, Tuberculosis and Lung Transplantation, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (F.S.); (H.K.); (W.S.); (O.A.); (E.V.); (T.G.)
| | - Fleur Steenberg
- Department of Pulmonary Diseases, Tuberculosis and Lung Transplantation, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (F.S.); (H.K.); (W.S.); (O.A.); (E.V.); (T.G.)
| | - Coretta van Leer-Buter
- Department of Virology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands;
| | - Huib Kerstjens
- Department of Pulmonary Diseases, Tuberculosis and Lung Transplantation, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (F.S.); (H.K.); (W.S.); (O.A.); (E.V.); (T.G.)
| | - Willie Steenhuis
- Department of Pulmonary Diseases, Tuberculosis and Lung Transplantation, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (F.S.); (H.K.); (W.S.); (O.A.); (E.V.); (T.G.)
| | - Onno Akkerman
- Department of Pulmonary Diseases, Tuberculosis and Lung Transplantation, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (F.S.); (H.K.); (W.S.); (O.A.); (E.V.); (T.G.)
| | - Erik Verschuuren
- Department of Pulmonary Diseases, Tuberculosis and Lung Transplantation, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (F.S.); (H.K.); (W.S.); (O.A.); (E.V.); (T.G.)
| | - Tji Gan
- Department of Pulmonary Diseases, Tuberculosis and Lung Transplantation, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (F.S.); (H.K.); (W.S.); (O.A.); (E.V.); (T.G.)
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21
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Chen CC, Hsu MK, Huang YJ, Lai MJ, Wu SW, Lin MH, Hung HS, Lin YC, Huang YT, Lee YF, Tsai MK, Lee CY. Protective Effect of Vaccine Doses and Antibody Titers Against SARS-CoV-2 Infection in Kidney Transplant Recipients. Transpl Int 2023; 36:11196. [PMID: 37383842 PMCID: PMC10294008 DOI: 10.3389/ti.2023.11196] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 05/30/2023] [Indexed: 06/30/2023]
Abstract
Patients undergoing kidney transplantation have a poor response to vaccination and a higher risk of disease progression of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The effectiveness of vaccine doses and antibody titer tests against the mutant variant in these patients remains unclear. We retrospectively analyzed the risk of SARS-CoV-2 infection in a single medical center according to vaccine doses and immune responses before the outbreak. Among 622 kidney transplant patients, there were 77 patients without vaccination, 26 with one dose, 74 with two doses, 357 with three, and 88 with four doses. The vaccination status and infection rate proportion were similar to the general population. Patients undergoing more than three vaccinations had a lower risk of infection (odds ratio = 0.6527, 95% CI = 0.4324-0.9937) and hospitalization (odds ratio = 0.3161, 95% CI = 0.1311-0.7464). Antibody and cellular responses were measured in 181 patients after vaccination. Anti-spike protein antibody titer of more than 1,689.3 BAU/mL is protective against SARS-CoV-2 infection (odds ratio = 0.4136, 95% CI = 0.1800-0.9043). A cellular response by interferon-γ release assay was not correlated with the disease (odds ratio = 1.001, 95% CI = 0.9995-1.002). In conclusion, despite mutant strain, more than three doses of the first-generation vaccine and high antibody titers provided better protection against the omicron variant for a kidney transplant recipient.
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Affiliation(s)
- Chien-Chia Chen
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Meng-Kai Hsu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Jen Huang
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Mei-Jun Lai
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Wei Wu
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Min-Huey Lin
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsu-Shan Hung
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Chun Lin
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Tsung Huang
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ya-Fen Lee
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Meng-Kun Tsai
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Yuan Lee
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
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22
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Ui M, Hirama T, Akiba M, Honda M, Kikuchi T, Okada Y. Cellular and humoral immune responses after a third dose of SARS-CoV-2 mRNA vaccine in lung transplant recipients in Japan. Vaccine 2023:S0264-410X(23)00663-1. [PMID: 37328349 PMCID: PMC10250153 DOI: 10.1016/j.vaccine.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 06/02/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Lung transplant (LTx) recipients are at higher risk of infection with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). There is an increasing demand for additional analysis regarding the efficacy and safety of after the initial series of mRNA SARS-CoV-2 vaccines in Japanese transplant recipients. METHOD In this open-label, nonrandomized prospective study carried out at Tohoku University Hospital, Sendai, Japan, LTx recipients and controls received third doses of either the BNT162b2 or the mRNA-1273 vaccine, and the cellular and humoral immune responses were analyzed. RESULTS A cohort of 39 LTx recipients and 38 controls participated in the study. The third dose of SARS-CoV-2 vaccine promoted much greater humoral responses at 53.9 % of LTx recipients than after the initial series at 28.2 % of patients without increasing the risk of adverse events. However, still fewer LTx recipients responded to the SARS-CoV-2 spike protein with the median IgG titer of 129.8 AU/mL and with the median IFN-γ level of 0.01 IU/mL when compared to controls with those of 7394 AU/mL and 0.70 IU/mL, respectively. CONCLUSION Although the third dose of mRNA vaccine in LTx recipients was effective and safe, impaired cellular and humoral responses to SARS-CoV-2 spike protein were noted. Given lower antibody production and establishing vaccine safety, repeating the administration of mRNA vaccine will lead to robust protection in such a high-risk population (jRCT1021210009).
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Affiliation(s)
- Masahiro Ui
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan; Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Niigata, Japan.
| | - Takashi Hirama
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan; Division of Organ Transplantation, Tohoku University Hospital, Sendai, Miyagi, Japan.
| | - Miki Akiba
- Division of Organ Transplantation, Tohoku University Hospital, Sendai, Miyagi, Japan.
| | - Masako Honda
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan.
| | - Toshiaki Kikuchi
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Niigata, Japan.
| | - Yoshinori Okada
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan; Division of Organ Transplantation, Tohoku University Hospital, Sendai, Miyagi, Japan.
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23
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Rossi M, Pessolano G, Gambaro G. What has vaccination against COVID-19 in CKD patients taught us? J Nephrol 2023; 36:1257-1266. [PMID: 37140817 PMCID: PMC10157569 DOI: 10.1007/s40620-023-01640-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 05/05/2023]
Abstract
Effective vaccination strategies are of crucial importance to protecting patients who are vulnerable to infections, such as patients with chronic kidney disease. This is because the decreased efficiency of the immune system in chronic kidney disease impairs vaccine-induced immunisation. COVID-19 has prompted investigation of the immune response to SARS-CoV-2 vaccines in chronic kidney disease and in kidney transplant recipients in an effort to improve efficacy. The seroconversion rate after two vaccine doses is reduced, especially in kidney transplant recipients. Furthermore, although the seroconversion rate in chronic kidney disease patients is as high as in healthy subjects, anti-spike antibody titres are lower than in healthy vaccinated individuals, and these titres decrease rapidly. Although the vaccine-induced anti-spike antibody titre correlates with neutralising antibody levels and with protection against COVID-19, the protective prognostic significance of their titre is decreased due to the emergence of SARS-CoV-2 variants other than the Wuhan index virus against which the original vaccines were produced. Cellular immunity is also relevant, and because of cross-reactivity to the spike protein, epitopes of different viral variants confer protection against newly emerging variants of SARS-CoV-2. A multi-dose vaccination strategy is the most effective way to obtain a sufficient serological response. In kidney transplant recipients, a 5-week discontinuation period from antimetabolite drugs in concomitance with vaccine administration may also increase the vaccine's efficacy. The newly acquired knowledge obtained from COVID-19 vaccination is of general interest for the success of other vaccinations in chronic kidney disease patients.
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Affiliation(s)
- Mattia Rossi
- Division of Nephrology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy.
| | - Giuseppina Pessolano
- Division of Nephrology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Giovanni Gambaro
- Division of Nephrology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
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24
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Werbel WA, Karaba AH, Chiang TPY, Massie AB, Brown DM, Watson N, Chahoud M, Thompson EA, Johnson AC, Avery RK, Cochran WV, Warren D, Liang T, Fribourg M, Huerta C, Samaha H, Klein SL, Bettinotti MP, Clarke WA, Sitaras I, Rouphael N, Cox AL, Bailey JR, Pekosz A, Tobian AAR, Durand CM, Bridges ND, Larsen CP, Heeger PS, Segev DL. Persistent SARS-CoV-2-specific immune defects in kidney transplant recipients following third mRNA vaccine dose. Am J Transplant 2023; 23:744-758. [PMID: 36966905 PMCID: PMC10037915 DOI: 10.1016/j.ajt.2023.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 03/26/2023]
Abstract
Kidney transplant recipients (KTRs) show poorer response to SARS-CoV-2 mRNA vaccination, yet response patterns and mechanistic drivers following third doses are ill-defined. We administered third monovalent mRNA vaccines to n = 81 KTRs with negative or low-titer anti-receptor binding domain (RBD) antibody (n = 39 anti-RBDNEG; n = 42 anti-RBDLO), compared with healthy controls (HCs, n = 19), measuring anti-RBD, Omicron neutralization, spike-specific CD8+%, and SARS-CoV-2-reactive T cell receptor (TCR) repertoires. By day 30, 44% anti-RBDNEG remained seronegative; 5% KTRs developed BA.5 neutralization (vs 68% HCs, P < .001). Day 30 spike-specific CD8+% was negative in 91% KTRs (vs 20% HCs; P = .07), without correlation to anti-RBD (rs = 0.17). Day 30 SARS-CoV-2-reactive TCR repertoires were detected in 52% KTRs vs 74% HCs (P = .11). Spike-specific CD4+ TCR expansion was similar between KTRs and HCs, yet KTR CD8+ TCR depth was 7.6-fold lower (P = .001). Global negative response was seen in 7% KTRs, associated with high-dose MMF (P = .037); 44% showed global positive response. Of the KTRs, 16% experienced breakthrough infections, with 2 hospitalizations; prebreakthrough variant neutralization was poor. Absent neutralizing and CD8+ responses in KTRs indicate vulnerability to COVID-19 despite 3-dose mRNA vaccination. Lack of neutralization despite CD4+ expansion suggests B cell dysfunction and/or ineffective T cell help. Development of more effective KTR vaccine strategies is critical. (NCT04969263).
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Affiliation(s)
- William A Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - Andrew H Karaba
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Teresa Po-Yu Chiang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Allan B Massie
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA; Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Diane M Brown
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Natasha Watson
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Maggie Chahoud
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth A Thompson
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Robin K Avery
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Willa V Cochran
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel Warren
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tao Liang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Miguel Fribourg
- Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Hady Samaha
- Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Sabra L Klein
- Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Maria P Bettinotti
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - William A Clarke
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ioannis Sitaras
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nadine Rouphael
- Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Andrea L Cox
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Medicine, Emory University, Atlanta, Georgia, USA; Bloomberg Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Justin R Bailey
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christine M Durand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nancy D Bridges
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Peter S Heeger
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dorry L Segev
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA; Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
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25
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Kabbani D, Yotis DM, Ferreira VH, Shalhoub S, Belga S, Tyagi V, Ierullo M, Kulasingam V, Hébert MJ, West L, Delisle JS, Racine N, De Serres SA, Cardinal H, Dieudé M, Humar A, Kumar D. Immunogenicity, Safety, and Breakthrough Severe Acute Respiratory Syndrome Coronavirus 2 Infections After Coronavirus Disease 2019 Vaccination in Organ Transplant Recipients: A Prospective Multicenter Canadian Study. Open Forum Infect Dis 2023; 10:ofad200. [PMID: 37213422 PMCID: PMC10199121 DOI: 10.1093/ofid/ofad200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/11/2023] [Indexed: 05/23/2023] Open
Abstract
Background Solid organ transplant (SOT) recipients are at risk for severe coronavirus disease 2019 (COVID-19), despite vaccination. Our study aimed to elucidate COVID-19 vaccine immunogenicity and evaluate adverse events such as hospitalization, rejection, and breakthrough infection in a SOT cohort. Methods We performed a prospective, observational study on 539 adult SOT recipients (age ≥18 years old) recruited from 7 Canadian transplant centers. Demographics including transplant characteristics, vaccine types, and immunosuppression and events such as hospitalization, infection, and rejection were recorded. Follow ups occurred every 4-6 weeks postvaccination and at 6 and 12 months from first dose. Serum was processed from whole blood to measure anti-receptor binding domain (RBD) antibodies of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein to assess immunogenicity. Results The COVID-19 vaccines were found to be safe in SOT recipients with low rates of rejection requiring therapy (0.7%). Immunogenicity improved after the third vaccine dose, yet 21% developed no anti-RBD response. Factors such as older age, lung transplantation, chronic kidney disease, and shorter duration from transplant were associated with decreased immunogenicity. Patients with at least 3 doses were protected from hospitalization when experiencing breakthrough infections. Significantly increased anti-RBD levels were observed in patients who received 3 doses and had breakthrough infection. Conclusions Three or four doses of COVID-19 vaccines were safe, increased immunogenicity, and protected against severe disease requiring hospitalization. Infection paired with multiple vaccinations significantly increased anti-RBD response. However, SOT populations should continue to practice infection prevention measures, and they should be prioritized for SARS-CoV-2 pre-exposure prophylactics and early therapeutics.
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Affiliation(s)
- Dima Kabbani
- Correspondence: Dima Kabbani, MD, MSc , Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, 1-124 Clinical Sciences Building 11304 83 Avenue Edmonton, AB Canada T6G 2G3 (). Deepali Kumar, MD, MSc, FRCP(C), FAST, Ajmera Transplant Centre, University Health Network, 585 University Ave., 11-PMB-174, Toronto, ON, Canada M5G 2N2 ()
| | - Demitra M Yotis
- Canadian Donation and Transplantation Research Program (CDTRP), Edmonton, Alberta, Canada
| | - Victor H Ferreira
- Transplant Infectious Diseases and Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada
| | - Sarah Shalhoub
- Division of Infectious Diseases, Department of Medicine, Western University, London, Ontario, Canada
| | - Sara Belga
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, and Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Varalika Tyagi
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew Ierullo
- Transplant Infectious Diseases and Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada
| | - Vathany Kulasingam
- Laboratory Medicine Program, University Health Network, University Health Network, University of Toronto, Ontario, Canada
| | - Marie-Josée Hébert
- Canadian Donation and Transplantation Research Program (CDTRP), Edmonton, Alberta, Canada
- Department of Medicine, Centre Hospitalier de l’Université de Montréal, Faculté de Médecine, Université de Montréal, Quebec, Canada
| | - Lori West
- Canadian Donation and Transplantation Research Program (CDTRP), Edmonton, Alberta, Canada
- Pediatric Cardiac Transplantation Program, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
- Alberta Transplant Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Jean-Sébastien Delisle
- Canadian Donation and Transplantation Research Program (CDTRP), Edmonton, Alberta, Canada
- Centre de Recherche de l’Hôpital Maisonneuve-Rosemoent, Montréal, Quebec, Canada
- Department of Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - Normand Racine
- Institut de Cardiologie de Montréal, Faculté de Médecine, Université de Montréal, Montréal, Quebec, Canada
| | - Sacha A De Serres
- Transplantation Unit, Renal Division, Department of Medicine, University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Héloïse Cardinal
- Centre de Recherche de l’Hôpital Maisonneuve-Rosemoent, Montréal, Quebec, Canada
| | - Mélanie Dieudé
- Canadian Donation and Transplantation Research Program (CDTRP), Edmonton, Alberta, Canada
- Héma-Québec, Montréal, Québec, Canada
- Microbiology, Infectiology and Immunology Department, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Research Center, Centre Hospitalier de L’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Atul Humar
- Transplant Infectious Diseases and Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada
| | - Deepali Kumar
- Correspondence: Dima Kabbani, MD, MSc , Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, 1-124 Clinical Sciences Building 11304 83 Avenue Edmonton, AB Canada T6G 2G3 (). Deepali Kumar, MD, MSc, FRCP(C), FAST, Ajmera Transplant Centre, University Health Network, 585 University Ave., 11-PMB-174, Toronto, ON, Canada M5G 2N2 ()
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26
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Boutin CA, Alamri M, Ison MG. Update on Covid-19: vaccines, timing of transplant after COVID-19 infection and use of positive donors. Curr Opin Organ Transplant 2023; 28:76-84. [PMID: 36809306 PMCID: PMC9992272 DOI: 10.1097/mot.0000000000001056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
PURPOSE OF REVIEW SARS-CoV-2 resulted in a global pandemic that had a chilling effect on transplantation early in the pandemic and continues to result in significant morbidity and mortality of transplant recipients. Over the past 2.5 years, our understanding of the clinical utility of vaccination and mAbs to prevent COVID-19 in solid organ transplant (SOT) recipients has been studied. Likewise, approach to donors and candidates with SARS-CoV-2 has been better understood. This review will attempt to summarize our current understanding of these important COVID-19 topics. RECENT FINDINGS Vaccination against SARS-CoV-2 is effective in reducing the risk of severe disease and death among transplant patients. Unfortunately, humoral and, to a lesser extent, cellular immune response to existing COVID-19 vaccines is reduced in SOT recipients compared with healthy controls. Additional doses of vaccine are required to optimize protection of this population and still may be insufficient in those who are highly immunosuppressed, those receiving belatacept, rituximab and other B-cell active mAbs. Until recently, mAbs were options for the prevention of SARS-CoV-2 but are markedly less effective with recent omicron variants. SARS-CoV-2-infected donors can generally be used for nonlung, nonsmall bowel transplants unless they have died of acute severe COVID-19 or COVID-19-associated clotting disorders. SUMMARY Our transplant recipients require a three-dose mRNA or adenovirus-vector and one dose of mRNA vaccine to be optimally protected initially; they then need to receive a bivalent booster 2+ months after completing their initial series. Most nonlung, nonsmall bowel donors with SARS-CoV-2 can be utilized as organ donors.
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Affiliation(s)
- Catherine-Audrey Boutin
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Maha Alamri
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael G. Ison
- Respiratory Diseases Branch, Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
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27
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Vanlerberghe B, Vrij C, Bogaerts K, Vermeersch P, Lagrou K, Molenberghs G, Rega F, Ceulemans LJ, van Raemdonck D, Jochmans I, Monbaliu D, Pirenne J, Vanuytsel T, Gillard P, Schoemans H, Cleemput JV, Kuypers D, Vos R, Nevens F, Verbeek J. SARS-CoV-2 vaccine antibody response and breakthrough infections in transplant recipients. J Med Virol 2023; 95:e28736. [PMID: 37185854 DOI: 10.1002/jmv.28736] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/01/2023] [Accepted: 04/03/2023] [Indexed: 05/17/2023]
Abstract
Rates and modulators of SARS-CoV-2 vaccine nonresponse and breakthrough infections remain unclear in serially vaccinated transplant recipients. In a prospective, mono-centric, observational study, 1878 adult solid organ and hematopoietic cell transplant recipients, with prior SARS-CoV-2 vaccination, were included between March 2021 and February 2022. SARS-CoV-2 anti-spike IgG antibodies were measured at inclusion and details on SARS-CoV-2 vaccine doses and infection were collected. No life-threatening adverse events were reported after a total of 4039 vaccine doses. In transplant recipients without prior SARS-CoV-2 infection (n = 1636), antibody response rates ranged widely, from 47% in lung transplant to 90% in liver transplant and 91% in hematopoietic cell transplant recipients after third vaccine dose. Antibody positivity rate and levels increased after each vaccine dose in all types of transplant recipients. In multivariable analysis, older age, chronic kidney disease and daily dose of mycophenolate and corticosteroids were negatively associated with antibody response rate. Overall rate of breakthrough infections was 25.2% and mainly (90.2%) occurred after third and fourth vaccine dose. Lung transplant recipients had the highest rates of severe breakthrough infection (10.5%) and death (2.5%). In multivariable analysis, older age, daily dose of mycophenolate and corticosteroids were associated with severe breakthrough infection. Transplant recipients with infection before first vaccine dose (n = 160) had higher antibody response rates and levels after each vaccine dose, and a significantly lower overall rate of breakthrough infections compared to those without prior infection. Antibody response after SARS-CoV-2 vaccination and rate of severe breakthrough infections vary largely between different transplant types and are modulated by specific risk factors. The observed heterogeneity supports a tailored approach against COVID-19 in transplant recipients.
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Affiliation(s)
- Benedict Vanlerberghe
- Department of Gastroenterology and Hepatology, Laboratory of Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Casper Vrij
- Department of Gastroenterology and Hepatology, Laboratory of Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Kris Bogaerts
- Department of Public Health and Critical Care, I-BioStat, KU Leuven & University Hasselt, Leuven & Hasselt, Belgium
| | - Pieter Vermeersch
- Department of Laboratory Medicine, Department of Microbiology, Immunology and Transplantation, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Katrien Lagrou
- Department of Laboratory Medicine, Department of Microbiology, Immunology and Transplantation, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Geert Molenberghs
- Department of Public Health and Critical Care, I-BioStat, KU Leuven & University Hasselt, Leuven & Hasselt, Belgium
| | - Filip Rega
- Laboratory of Cardiovascular Sciences, Department of Cardiac Surgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Laurens J Ceulemans
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Thoracic Surgery, University Hospitals Leuven, CHROMETA, KU Leuven, Leuven, Belgium
| | - Dirk van Raemdonck
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Thoracic Surgery, University Hospitals Leuven, CHROMETA, KU Leuven, Leuven, Belgium
| | - Ina Jochmans
- Laboratory of Microbiology, Immunology and Transplantation, Department of Abdominal Transplant Surgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Diethard Monbaliu
- Laboratory of Microbiology, Immunology and Transplantation, Department of Abdominal Transplant Surgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Jacques Pirenne
- Laboratory of Microbiology, Immunology and Transplantation, Department of Abdominal Transplant Surgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Tim Vanuytsel
- Department of Gastroenterology and Hepatology, Laboratory of Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Pieter Gillard
- Laboratory of Clinical and Experimental Endocrinology, Department of Endocrinology, University Hospitals Leuven, CHROMETA, KU Leuven, Leuven, Belgium
| | - Hélène Schoemans
- Department of Public Health and Primary Care, Department of Hematology, University Hospitals Leuven, ACCENT VV, KU Leuven, Leuven, Belgium
| | - Johan Van Cleemput
- Laboratory of Cardiovascular Sciences, Department of Cardiology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Dirk Kuypers
- Laboratory of Microbiology, Immunology and Transplantation, Department of Nephrology and Renal Transplantation, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Robin Vos
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Respiratory Diseases, University Hospitals Leuven, CHROMETA, KU Leuven, Leuven, Belgium
| | - Frederik Nevens
- Department of Gastroenterology and Hepatology, Laboratory of Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Jef Verbeek
- Department of Gastroenterology and Hepatology, Laboratory of Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
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Tan TT, Ng HJ, Young B, Khan BA, Shetty V, Azmi N, Clissold S. Effectiveness of vaccination against SARS-CoV-2 and the need for alternative preventative approaches in immunocompromised individuals: a narrative review of systematic reviews. Expert Rev Vaccines 2023; 22:341-365. [PMID: 36920116 DOI: 10.1080/14760584.2023.2191716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including administration of booster doses, continues to be the most effective method for controlling COVID-19-related complications including progression to severe illness and death.However, there is mounting evidence that more needs to be done to protect individuals with compromised immune function. AREAS COVERED Here, we review the effectiveness of COVID-19 vaccination in immunocompromised patients, including those with primary immunodeficiencies, HIV, cancer (including hematological malignancies), solid organ transplant recipients and chronic kidney disease, as reported in systematic reviews/meta-analyses published over a 12-month period in PubMed. Given the varied responses to vaccination patients with compromised immune function, a major goal of this analysis was to try to identify specific risk-factors related to vaccine failure. EXPERT OPINION COVID-19 remains a global problem, with new variants of concern emerging at regular intervals. There is an ongoing need for optimal vaccine strategies to combat the pandemic. In addition, alternative treatment approaches are needed for immunocompromised patients who may not mount an adequate immune response to current COVID-19 vaccines. Identification of high-risk patients, and the introduction of newer antiviral approaches such as monoclonal antibodies, will offer physicians therapeutic options for such vulnerable individuals.
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Affiliation(s)
- Thuan Tong Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Heng Joo Ng
- Department of Haematology, Singapore General Hospital, Singapore, Singapore
| | - Barnaby Young
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - Behram Ali Khan
- Medical Services Department, The National Kidney Foundation, Singapore and Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Effect of a Fourth Dose of mRNA Vaccine and of Immunosuppression in Preventing SARS-CoV-2 Breakthrough Infections in Heart Transplant Patients. Microorganisms 2023; 11:microorganisms11030755. [PMID: 36985328 PMCID: PMC10053932 DOI: 10.3390/microorganisms11030755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/24/2023] [Accepted: 03/10/2023] [Indexed: 03/17/2023] Open
Abstract
Patients with heart transplantation (HT) have an increased risk of COVID-19 disease and the efficacy of vaccines on antibody induction is lower, even after three or four doses. The aim of our study was to assess the efficacy of four doses on infections and their interplay with immunosuppression. We included in this retrospective study all adult HT patients (12/21–11/22) without prior infection receiving a third or fourth dose of mRNA vaccine. The endpoints were infections and the combined incidence of ICU hospitalizations/death after the last dose (6-month survival rate). Among 268 patients, 62 had an infection, and 27.3% received four doses. Following multivariate analysis, three vs. four doses, mycophenolate (MMF) therapy, and HT < 5 years were associated with an increased risk of infection. MMF ≥ 2000 mg/day independently predicted infection, together with the other variables, and was associated with ICU hospitalization/death. Patients on MMF had lower levels of anti-RBD antibodies, and a positive antibody response after the third dose was associated with a lower probability of infection. In HT patients, a fourth dose of vaccine against SARS-CoV-2 reduces the risk of infection at six months. Mycophenolate, particularly at high doses, reduces the clinical effectiveness of the fourth dose and the antibody response to the vaccine.
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30
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Fuchs T, Appelt D, Ellemunter H. Is There a Difference in Immune Response to SARS-CoV-2 Vaccination between Liver and Lung Transplant Patients with Cystic Fibrosis? Vaccines (Basel) 2023; 11:vaccines11030657. [PMID: 36992241 DOI: 10.3390/vaccines11030657] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/08/2023] [Accepted: 03/11/2023] [Indexed: 03/17/2023] Open
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.
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Affiliation(s)
- Teresa Fuchs
- Department of Child and Adolescent Health, Paediatrics III, Cystic Fibrosis Centre Innsbruck, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Dorothea Appelt
- Department of Child and Adolescent Health, Paediatrics III, Cystic Fibrosis Centre Innsbruck, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Helmut Ellemunter
- Department of Child and Adolescent Health, Paediatrics III, Cystic Fibrosis Centre Innsbruck, Medical University of Innsbruck, 6020 Innsbruck, Austria
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Jongkees MJ, Geers D, Hensley KS, Huisman W, GeurtsvanKessel CH, Bogers S, Gommers L, Papageorgiou G, Jochems SP, den Hollander JG, Schippers EF, Ammerlaan HSM, Bierman WFW, van der Valk M, Berrevoets MAH, Soetekouw R, Langebeek N, Bruns AHW, Leyten EMS, Sigaloff KCE, van Vonderen MGA, Delsing CE, Branger J, Katsikis PD, Mueller YM, de Vries RD, Rijnders BJA, Brinkman K, Rokx C, Roukens AHE. Immunogenicity of an Additional mRNA-1273 SARS-CoV-2 Vaccination in People With HIV With Hyporesponse After Primary Vaccination. J Infect Dis 2023; 227:651-662. [PMID: 36402141 PMCID: PMC9978319 DOI: 10.1093/infdis/jiac451] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/09/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The COVIH study is a prospective coronavirus disease 2019 (COVID-19) vaccination study in 1154 people with HIV (PWH), of whom 14% showed reduced antibody levels after primary vaccination. We evaluated whether an additional vaccination boosts immune responses in these hyporesponders. METHODS The primary end point was the increase in antibodies 28 days after additional mRNA-1273 vaccination. Secondary end points included neutralizing antibodies, S-specific T-cell and B-cell responses, and reactogenicity. RESULTS Of the 66 participants, 40 previously received 2 doses ChAdOx1-S, 22 received 2 doses BNT162b2, and 4 received a single dose Ad26.COV2.S. The median age was 63 years (interquartile range [IQR], 60-66), 86% were male, and median CD4+ T-cell count was 650/μL (IQR, 423-941). The mean S1-specific antibody level increased from 35 binding antibody units (BAU)/mL (95% confidence interval [CI], 24-46) to 4317 BAU/mL (95% CI, 3275-5360) (P < .0001). Of all participants, 97% showed an adequate response and the 45 antibody-negative participants all seroconverted. A significant increase in the proportion of PWH with ancestral S-specific CD4+ T cells (P = .04) and S-specific B cells (P = .02) was observed. CONCLUSIONS An additional mRNA-1273 vaccination induced a robust serological response in 97% of PWH with a hyporesponse after primary vaccination. Clinical Trials Registration. EUCTR2021-001054-57-N.
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Affiliation(s)
- Marlou J Jongkees
- Department of Internal Medicine, Section Infectious Diseases, and Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Daryl Geers
- Department of Viroscience, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Kathryn S Hensley
- Department of Internal Medicine, Section Infectious Diseases, and Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Wesley Huisman
- Department of Parasitology, Leiden University Centre for Infectious Diseases, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Susanne Bogers
- Department of Viroscience, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Lennert Gommers
- Department of Viroscience, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Grigorios Papageorgiou
- Department of Biostatistics, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Simon P Jochems
- Department of Parasitology, Leiden University Centre for Infectious Diseases, Leiden University Medical Centre, Leiden, the Netherlands
| | - Jan G den Hollander
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands
| | - Emile F Schippers
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Internal Medicine, Haga Teaching Hospital, the Hague, the Netherlands
| | - Heidi S M Ammerlaan
- Department of Internal Medicine, Catharina Hospital, Eindhoven, the Netherlands
| | - Wouter F W Bierman
- Department of Internal Medicine and Infectious Diseases, University Medical Centre Groningen, Groningen, the Netherlands
| | - Marc van der Valk
- Department of Internal Medicine and Infectious Diseases, DC Klinieken, Amsterdam, the Netherlands.,Department of Infectious Diseases, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Marvin A H Berrevoets
- Department of Internal Medicine, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands
| | - Robert Soetekouw
- Department of Internal Medicine and Infectious Diseases, Spaarne Gasthuis, Haarlem, the Netherlands
| | - Nienke Langebeek
- Department of Internal Medicine and Infectious Diseases, Rijnstate Hospital, Arnhem, the Netherlands
| | - Anke H W Bruns
- Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Eliane M S Leyten
- Department of Internal Medicine and Infectious Diseases, Haaglanden Medical Centre, the Hague, the Netherlands
| | - Kim C E Sigaloff
- Department of Infectious Diseases, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | | | - Corine E Delsing
- Department of Internal Medicine and Infectious Diseases, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Judith Branger
- Department of Internal Medicine, Flevo Hospital, Almere, the Netherlands
| | - Peter D Katsikis
- Department of Immunology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Yvonne M Mueller
- Department of Immunology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Rory D de Vries
- Department of Viroscience, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Bart J A Rijnders
- Department of Internal Medicine, Section Infectious Diseases, and Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Kees Brinkman
- Department of Internal Medicine and Infectious Diseases, OLVG Hospital, Amsterdam, the Netherlands
| | - Casper Rokx
- Department of Internal Medicine, Section Infectious Diseases, and Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Anna H E Roukens
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, the Netherlands
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Meziyerh S, Bouwmans P, van Gelder T, van der Helm D, Messchendorp L, van der Boog PJM, de Fijter JW, Moes DJAR, de Vries APJ. Mycophenolic Acid Exposure Determines Antibody Formation Following SARS-CoV-2 Vaccination in Kidney Transplant Recipients: A Nested Cohort Study. Clin Pharmacol Ther 2023. [PMID: 36789469 DOI: 10.1002/cpt.2872] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/07/2023] [Indexed: 02/16/2023]
Abstract
Despite (repeated) boosting, kidney transplant recipients (KTRs) may remain at increased risk of severe COVID-19 since a substantial number of individuals remain seronegative or with low antibody titers. In particular, mycophenolic acid use has been shown to affect antibody formation negatively and may be an important modifiable risk factor. We investigated the exposure-response relationship between mycophenolic acid 12-hour area under the curve (AUC0-12h ) exposure and seroconversion including antibody titers after vaccination using mRNA-1273 SARS-CoV-2 vaccine (Moderna) in 316 KTRs from our center that participated in the national Dutch renal patients COVID-19 vaccination - long term efficacy and safety of SARS-CoV-2 vaccination in kidney disease patients vaccination study. After two vaccination doses, 162 (51%) KTRs seroconverted. KTRs treated with mycophenolic acid showed less seroconversion and lower antibody titers compared with KTRs without mycophenolic acid (44% vs. 77%, and 36 binding antibody units (BAU)/mL vs. 340 BAU/mL; P < 0.001). The mean mycophenolic acid AUC0-12h exposure was significantly lower in KTRs who seroconverted compared with KTRs who did not (39 vs. 29 mg⋅h/L; P < 0.001). High mycophenolic acid exposure (±90 mg⋅h/L) and no exposure to mycophenolic acid resulted in a seroconversion rate ranging from 10% to 80%. Every 10 mg⋅h/L increase in mycophenolic acid AUC0-12h gave an adjusted odds ratio for seroconversion of 0.87 (95% confidence interval (CI), 0.79-0.97; P = 0.010) and 0.89 (95% CI, 0.85-0.93; P < 0.001) for KTRs on dual and triple maintenance immunosuppressive therapy, respectively. Higher mycophenolic acid AUC0-12h correlated with lower antibody titers (R = 0.44, P < 0.001). This study demonstrates the exposure-response relationship between gold standard mycophenolic acid exposure and antibody formation to support interventional studies investigating mycophenolic acid adjustment to improve antibody formation after further boosting.
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Affiliation(s)
- Soufian Meziyerh
- Department of Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, The Netherlands.,Leiden University Medical Center Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Pim Bouwmans
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht School for Cardiovascular Disease, University of Maastricht, Maastricht, The Netherlands
| | - Teun van Gelder
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Danny van der Helm
- Leiden University Medical Center Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Lianne Messchendorp
- Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul J M van der Boog
- Department of Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, The Netherlands.,Leiden University Medical Center Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Johan W de Fijter
- Department of Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, The Netherlands.,Leiden University Medical Center Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Dirk Jan A R Moes
- Cardiovascular Research Institute Maastricht School for Cardiovascular Disease, University of Maastricht, Maastricht, The Netherlands
| | - Aiko P J de Vries
- Department of Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, The Netherlands.,Leiden University Medical Center Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
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Humoral and cellular immune correlates of protection against COVID-19 in kidney transplant recipients. Am J Transplant 2023; 23:649-658. [PMID: 36773936 PMCID: PMC9911984 DOI: 10.1016/j.ajt.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Abstract
As solid organ transplant recipients are at high risk of severe COVID-19 and respond poorly to primary SARS-CoV-2 mRNA vaccination, they have been prioritized for booster vaccination. However, an immunological correlate of protection has not been identified in this vulnerable population. We conducted a prospective monocentric cohort study of 65 kidney transplant recipients who received 3 doses of BNT162b2 mRNA vaccine. Associations among breakthrough infection (BTI), vaccine responses, and patient characteristics were explored in 54 patients. Symptomatic COVID-19 was diagnosed in 32% of kidney transplant recipients during a period of 6 months after booster vaccination. During this period, SARS-CoV-2 delta and omicron were the dominant variants in the general population. Univariate Analyses identified the avidity of SARS-CoV-2 receptor binding domain binding IgG, neutralizing antibodies, and SARS-CoV-2 S2-specific interferon gamma responses as correlates of protection against BTI. No demographic or clinical parameter correlated with the risk of BTI. In multivariate analysis, the risk of BTI was best predicted by neutralizing antibody and S2-specific interferon gamma responses. In conclusion, T cell responses may help compensate for the suboptimal antibody response to booster vaccination in kidney transplant recipients. Further studies are needed to confirm these findings.
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Shishido AA, Barnes AH, Narayanan S, Chua JV. COVID-19 Vaccines-All You Want to Know. Semin Respir Crit Care Med 2023; 44:143-172. [PMID: 36646092 DOI: 10.1055/s-0042-1759779] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic has led to an unprecedented public health crisis. The collective global response has led to production of multiple safe and effective vaccines utilizing novel platforms to combat the virus that have propelled the field of vaccinology forward. Significant challenges to universal vaccine effectiveness remain, including immune evasion by SARS-CoV-2 variants, waning of immune response, inadequate knowledge of correlates of protection, and dosing in special populations. This review serves as a detailed evaluation of the development of the current SARS-CoV-2 vaccines, their effectiveness, and challenges to their deployment as a preventive tool.
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Affiliation(s)
- Akira A Shishido
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland.,Division of Infectious Diseases, Virginia Commonwealth University, Richmond, Virginia
| | - Ashley H Barnes
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Shivakumar Narayanan
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Joel V Chua
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
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35
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Quartuccio L, De Marchi G, Domenis R, Cabas N, Guella S, Paradiso A, Fabro C, Beltrami AP, De Vita S, Curcio F. Humoral and T-Cell Mediated Response after the Third Dose of mRNA Vaccines in Patients with Systemic Lupus Erythematosus on Belimumab. J Clin Med 2023; 12:jcm12031083. [PMID: 36769731 PMCID: PMC9917399 DOI: 10.3390/jcm12031083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/12/2023] [Accepted: 01/29/2023] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To evaluate humoral and T-cell cellular-mediated immune response after three doses of SARS-CoV-2 mRNA vaccines in patients with systemic lupus erythematosus (SLE) under Belimumab. PATIENTS AND METHODS 12 patients on Belimumab and 13 age-matched healthy volunteers were recruited. Patients were in remission or in low disease activity, and they were taking no corticosteroids or only low doses. None of the patients and controls had detectable anti-SARS-CoV-2 antibodies due to previous exposure to the virus. All the patients received three doses of mRNA anti-SARS-CoV-2 vaccines and the humoral and cellular-mediated response were tested 4 weeks after the second dose (T0), 6 months after the second dose (T1) and 4 weeks after the third dose (T2). Comparison with the control group was performed at time T0 (i.e., 4 weeks after the second dose). Total anti-SARS-CoV-2 RBD antibodies were analyzed using a diagnostic assay, while cellular-mediated response was evaluated using the interferon-gamma release assay (IGRA). RESULTS A humoral response was documented in all the patients at T0 (median 459; IQR 225.25-758.5), but the antibody titer significantly declined from T0 to T1 (median 44.7; IQR: 30.3-202; p = 0.0066). At T2, the antibody titer significantly increased from T1 (median 2500; IQR: 2500-2500), and it was not different from T0 (respectively p < 0.0001, p = 0.66). Cellular-mediated response significantly declined from T0 to T1 (p = 0.003) but not from T0 to T2 (p = 0.3). No differences were found between patients and controls at T0 as regards both humoral and cellular responses (p = 1.0 and p = 0.09 for humoral and cellular responses, respectively). CONCLUSION The third dose of mRNA COVID-19 vaccine can restore both humoral and cellular immune response in SLE patients on Belimumab.
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Affiliation(s)
- Luca Quartuccio
- Division of Rheumatology, Academic Hospital “Santa Maria della Misericordia”, ASUFC, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
- Correspondence: (L.Q.); (G.D.M.)
| | - Ginevra De Marchi
- Division of Rheumatology, Academic Hospital “Santa Maria della Misericordia”, ASUFC, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
- Correspondence: (L.Q.); (G.D.M.)
| | - Rossana Domenis
- Institute of Clinical Pathology, Academic Hospital “Santa Maria della Misericordia”, ASUFC, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Nicola Cabas
- Division of Rheumatology, Academic Hospital “Santa Maria della Misericordia”, ASUFC, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Silvia Guella
- Division of Rheumatology, Academic Hospital “Santa Maria della Misericordia”, ASUFC, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Antonella Paradiso
- Institute of Clinical Pathology, Academic Hospital “Santa Maria della Misericordia”, ASUFC, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Cinzia Fabro
- Division of Rheumatology, Academic Hospital “Santa Maria della Misericordia”, ASUFC, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Antonio Paolo Beltrami
- Institute of Clinical Pathology, Academic Hospital “Santa Maria della Misericordia”, ASUFC, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Salvatore De Vita
- Division of Rheumatology, Academic Hospital “Santa Maria della Misericordia”, ASUFC, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Francesco Curcio
- Institute of Clinical Pathology, Academic Hospital “Santa Maria della Misericordia”, ASUFC, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
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Hogan JI, Duerr R, Dimartino D, Marier C, Hochman SE, Mehta S, Wang G, Heguy A. Remdesivir Resistance in Transplant Recipients With Persistent Coronavirus Disease 2019. Clin Infect Dis 2023; 76:342-345. [PMID: 36156117 PMCID: PMC9619446 DOI: 10.1093/cid/ciac769] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/30/2022] [Accepted: 09/13/2022] [Indexed: 01/18/2023] Open
Abstract
New mutations conferring resistance to SARS-CoV-2 therapeutics have important clinical implications. We describe the first cases of an independently acquired V792I RNA-dependent RNA polymerase mutation developing in renal transplant recipients after remdesivir exposure. Our work underscores the need for augmented efforts to identify concerning mutations and address their clinical implications.
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Affiliation(s)
- John I Hogan
- Department of Medicine, NYU Long Island School of Medicine, Mineola, New York, USA
| | - Ralf Duerr
- Department of Microbiology, NYU Grossman School of Medicine, New York, New York, USA
| | - Dacia Dimartino
- Genome Technology Center, NYU Langone Health, New York, New York, USA
| | - Christian Marier
- Genome Technology Center, NYU Langone Health, New York, New York, USA
| | - Sarah E Hochman
- Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Sapna Mehta
- Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Guiqing Wang
- Department of Pathology, NYU Grossman School of Medicine, New York, New York, USA
| | - Adriana Heguy
- Genome Technology Center, NYU Langone Health, New York, New York, USA
- Department of Pathology, NYU Grossman School of Medicine, New York, New York, USA
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Rezahosseini O, Hamm SR, Heftdal LD, Pérez-Alós L, Møller DL, Perch M, Madsen JR, Hald A, Hansen CB, Armenteros JJA, Pries-Heje MM, Hasselbalch RB, Fogh K, Frikke-Schmidt R, Hilsted LM, Sørensen E, Ostrowski SR, Harboe ZB, Iversen K, Bundgaard H, Sørensen SS, Rasmussen A, Garred P, Nielsen SD. 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. Front Immunol 2023; 13:1075423. [PMID: 36713395 PMCID: PMC9880190 DOI: 10.3389/fimmu.2022.1075423] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/29/2022] [Indexed: 01/15/2023] Open
Abstract
Introduction We 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. Methods We included adult liver, lung, and kidney transplant recipients, and controls were selected from a parallel cohort of healthcare workers. Results At 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. Conclusion In 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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Affiliation(s)
- Omid Rezahosseini
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sebastian Rask Hamm
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Line Dam Heftdal
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Laura Pérez-Alós
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Dina Leth Møller
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michael Perch
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Johannes Roth Madsen
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Annemette Hald
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Cecilie Bo Hansen
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jose Juan Almagro Armenteros
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mia Marie Pries-Heje
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rasmus Bo Hasselbalch
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark,Department of Emergency Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kamille Fogh
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark,Department of Emergency Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ruth Frikke-Schmidt
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Linda Maria Hilsted
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Erik Sørensen
- Department of Clinical Immunology, Section 2034, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sisse Rye Ostrowski
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,Department of Clinical Immunology, Section 2034, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Zitta Barrella Harboe
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,Department of Pulmonary and Infectious Diseases, Hospital of North Zealand, Copenhagen University Hospital, Hillerød, Denmark
| | - Kasper Iversen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark,Department of Emergency Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Schwartz Sørensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,Department of Nephrology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Allan Rasmussen
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Garred
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,*Correspondence: Susanne Dam Nielsen,
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38
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Natori Y, Martin E, Mattiazzi A, Arosemena L, Ortigosa-Goggins M, Shobana S, Roth D, Kupin WL, Burke GW, Ciancio G, Morsi M, Phancao A, Munagala MR, Butrous H, Manickavel S, Sinha N, Sota K, Pallikkuth S, Bini J, Simkins J, Anjan S, Vianna RM, Guerra G. A Pilot Single-Blinded, Randomized, Controlled Trial Comparing BNT162b2 vs. JNJ-78436735 Vaccine as the Third Dose After Two Doses of BNT162b2 Vaccine in Solid Organ Transplant Recipients. Transpl Int 2023; 36:10938. [PMID: 37091963 PMCID: PMC10113439 DOI: 10.3389/ti.2023.10938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/06/2023] [Indexed: 04/25/2023]
Abstract
Solid Organ Transplant (SOT) recipients are at significant higher risk for COVID-19 and due to immunosuppressive medication, the immunogenicity after vaccination is suboptimal. In the previous studies, booster method showed significant benefit in this population. In the current study, we compared using a mix-and-match method vs. same vaccine as a third dose in SOT recipients. This was a patient-blinded, single center, randomized controlled trial comparing BNT162b2 vs. JNJ-78436735 vaccine as the third dose after two doses of BNT162b2 vaccine. We included adult SOT recipients with functional graft who had received two doses of BNT162b2 vaccine. Participants were randomly assigned to receive either BNT162b2 or JNJ-78436735 in one-to-one ratio. Primary outcome was SARS-CoV-2 IgG positivity at 1 month after the third dose. Sixty SOT recipients, including 36 kidney, 12 liver, 2 lung, 3 heart, and 5 combined transplants, were enrolled, and 57 recipients were analyzed per protocol. There were no statistically significant differences between the two vaccine protocols for IgG positivity (83.3% vs. 85.2% for BNT162b2 and JNJ-78436735, respectively, p = 0.85, Odds Ratio 0.95, 95% Confidence Interval 0.23-4.00). Comparison of the geometric mean titer demonstrated a higher trend with BNT162b2 (p = 0.09). In this pilot randomized controlled trial comparing mix and match method vs. uniform vaccination in SOT recipients, both vaccines were safely used. Since this was a small sample sized study, there was no statistically significant difference in immunogenicity; though, the mix and match method showed relatively lower geometric mean titer, as compared to uniform vaccine. Further studies need to be conducted to determine duration of this immunogenicity. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT05047640?term=20210641&draw=2&rank=1, identifier 20210641.
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Affiliation(s)
- Yoichiro Natori
- Miami Transplant Institute, Jackson Health System, Miami, FL, United States
- Division of Infectious Disease, Department of Medicine, Miller School of Medicine Miami, University of Miami, Miami, FL, United States
| | - Eric Martin
- Miami Transplant Institute, Jackson Health System, Miami, FL, United States
- Division of Hepatology, Department of Medicine, Miller School of Medicine Miami, University of Miami, Miami, FL, United States
| | - Adela Mattiazzi
- Miami Transplant Institute, Jackson Health System, Miami, FL, United States
- Division of Nephrology, Department of Medicine, Miller School of Medicine Miami, University of Miami, Miami, FL, United States
| | - Leopoldo Arosemena
- Miami Transplant Institute, Jackson Health System, Miami, FL, United States
- Division of Hepatology, Department of Medicine, Miller School of Medicine Miami, University of Miami, Miami, FL, United States
| | - Mariella Ortigosa-Goggins
- Miami Transplant Institute, Jackson Health System, Miami, FL, United States
- Division of Nephrology, Department of Medicine, Miller School of Medicine Miami, University of Miami, Miami, FL, United States
| | - Sivan Shobana
- Miami Transplant Institute, Jackson Health System, Miami, FL, United States
- Division of Nephrology, Department of Medicine, Miller School of Medicine Miami, University of Miami, Miami, FL, United States
| | - David Roth
- Miami Transplant Institute, Jackson Health System, Miami, FL, United States
- Division of Nephrology, Department of Medicine, Miller School of Medicine Miami, University of Miami, Miami, FL, United States
| | - Warren Lee Kupin
- Miami Transplant Institute, Jackson Health System, Miami, FL, United States
- Division of Nephrology, Department of Medicine, Miller School of Medicine Miami, University of Miami, Miami, FL, United States
| | - George William Burke
- Miami Transplant Institute, Jackson Health System, Miami, FL, United States
- Department of Surgery, Miller School of Medicine Miami, University of Miami, Miami, FL, United States
| | - Gaetano Ciancio
- Miami Transplant Institute, Jackson Health System, Miami, FL, United States
- Department of Surgery, Miller School of Medicine Miami, University of Miami, Miami, FL, United States
| | - Mahmoud Morsi
- Miami Transplant Institute, Jackson Health System, Miami, FL, United States
- Department of Surgery, Miller School of Medicine Miami, University of Miami, Miami, FL, United States
| | - Anita Phancao
- Miami Transplant Institute, Jackson Health System, Miami, FL, United States
- Division of Cardiology, Department of Medicine, Miller School of Medicine Miami, University of Miami, Miami, FL, United States
| | - Mrudula R. Munagala
- Miami Transplant Institute, Jackson Health System, Miami, FL, United States
- Division of Cardiology, Department of Medicine, Miller School of Medicine Miami, University of Miami, Miami, FL, United States
| | - Hoda Butrous
- Miami Transplant Institute, Jackson Health System, Miami, FL, United States
- Division of Cardiology, Department of Medicine, Miller School of Medicine Miami, University of Miami, Miami, FL, United States
| | - Suresh Manickavel
- Miami Transplant Institute, Jackson Health System, Miami, FL, United States
- Division of Pulmonology, Department of Medicine, Miller School of Medicine Miami, University of Miami, Miami, FL, United States
| | - Neeraj Sinha
- Miami Transplant Institute, Jackson Health System, Miami, FL, United States
- Division of Pulmonology, Department of Medicine, Miller School of Medicine Miami, University of Miami, Miami, FL, United States
| | - Katherine Sota
- Miami Transplant Institute, Jackson Health System, Miami, FL, United States
| | - Suresh Pallikkuth
- Division of Microbiology, Department of Medicine, Miller School of Medicine Miami, University of Miami, Miami, FL, United States
| | - Julia Bini
- Miami Transplant Institute, Jackson Health System, Miami, FL, United States
- Division of Infectious Disease, Department of Medicine, Miller School of Medicine Miami, University of Miami, Miami, FL, United States
| | - Jacques Simkins
- Miami Transplant Institute, Jackson Health System, Miami, FL, United States
- Division of Infectious Disease, Department of Medicine, Miller School of Medicine Miami, University of Miami, Miami, FL, United States
| | - Shweta Anjan
- Miami Transplant Institute, Jackson Health System, Miami, FL, United States
- Division of Infectious Disease, Department of Medicine, Miller School of Medicine Miami, University of Miami, Miami, FL, United States
| | - Rodrigo M. Vianna
- Miami Transplant Institute, Jackson Health System, Miami, FL, United States
- Department of Surgery, Miller School of Medicine Miami, University of Miami, Miami, FL, United States
| | - Giselle Guerra
- Miami Transplant Institute, Jackson Health System, Miami, FL, United States
- Division of Nephrology, Department of Medicine, Miller School of Medicine Miami, University of Miami, Miami, FL, United States
- *Correspondence: Giselle Guerra,
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Fatima I, Duong N. The impact of COVID-19 on liver transplantation: challenges and perspectives. Therap Adv Gastroenterol 2023; 16:17562848231171452. [PMID: 37180361 PMCID: PMC10172841 DOI: 10.1177/17562848231171452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/06/2023] [Indexed: 05/16/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic presented unique challenges to patients with decompensated cirrhosis awaiting transplant, with respect to accessing medical facilities for routine clinic visits, imaging, laboratory workup, or endoscopies. There was a delay in organ procurement that led to a decrease in the number of liver transplants (LTs) and an increase in the morality of waitlisted patients at the beginning of the pandemic. LT numbers later equalized to pre-pandemic numbers due to combined efforts and adaptability of transplant centers as well as dynamic guidelines. Due to being immunosuppressed, the demographics of LT patients were at an increased risk of infection. Although there is a higher rate of mortality and morbidity in patients with chronic liver disease, LT itself is not a risk factor for mortality in COVID-19. There was no difference in overall mortality in LT patients compared to non-LT patients, and mortality risk factors were the same: age, hypertension, diabetes, obesity, and chronic kidney disease. The most common causes of death were respiratory complications. Liver-related deaths were reported in 1.6% of patients. The optimal timing of liver transplantation post-infection depends on various factors, such as the severity of liver injury, the presence of comorbidities, and the progression of the underlying liver disease. There is not enough data available on COVID-19 cholangiopathy and the number of cases that will be seen in the future that will require LT. There are some concerns of lower immunogenicity of COVID-19 vaccines in LT patients but available evidence suggests that the vaccines are safe and well-tolerated.
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Affiliation(s)
| | - Nikki Duong
- Department of Gastroenterology, Hepatology and
Nutrition, Virginia Commonwealth University Medical Center, Richmond, VA,
USA
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40
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Bouwmans P, Messchendorp AL, Imhof C, Sanders JSF, Hilbrands LB, Reinders MEJ, Vart P, Bemelman FJ, Abrahams AC, van den Dorpel RMA, Ten Dam MAGJ, de Vries APJ, Rispens T, Steenhuis M, Gansevoort RT, Hemmelder MH. Impact of immunosuppressive treatment and type of SARS-CoV-2 vaccine on antibody levels after three vaccinations in patients with chronic kidney disease or kidney replacement therapy. Clin Kidney J 2022; 16:528-540. [PMID: 36865021 PMCID: PMC9972832 DOI: 10.1093/ckj/sfac249] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Indexed: 11/26/2022] Open
Abstract
Background Patients with chronic kidney disease (CKD) or kidney replacement therapy demonstrate lower antibody levels after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination compared with healthy controls. In a prospective cohort, we analysed the impact of immunosuppressive treatment and type of vaccine on antibody levels after three SARS-CoV-2 vaccinations. Methods Control subjects (n = 186), patients with CKD G4/5 (n = 400), dialysis patients (n = 480) and kidney transplant recipients (KTR) (n = 2468) were vaccinated with either mRNA-1273 (Moderna), BNT162b2 (Pfizer-BioNTech) or AZD1222 (Oxford/AstraZeneca) in the Dutch SARS-CoV-2 vaccination programme. Third vaccination data were available in a subgroup of patients (n = 1829). Blood samples and questionnaires were obtained 1 month after the second and third vaccination. Primary endpoint was the antibody level in relation to immunosuppressive treatment and type of vaccine. Secondary endpoint was occurrence of adverse events after vaccination. Results Antibody levels after two and three vaccinations were lower in patients with CKD G4/5 and dialysis patients with immunosuppressive treatment compared with patients without immunosuppressive treatment. After two vaccinations, we observed lower antibody levels in KTR using mycophenolate mofetil (MMF) compared with KTR not using MMF [20 binding antibody unit (BAU)/mL (3-113) vs 340 BAU/mL (50-1492), P < .001]. Seroconversion was observed in 35% of KTR using MMF, compared with 75% of KTR not using MMF. Of the KTR who used MMF and did not seroconvert, eventually 46% seroconverted after a third vaccination. mRNA-1273 induces higher antibody levels as well as a higher frequency of adverse events compared with BNT162b2 in all patient groups. Conclusions Immunosuppressive treatment adversely affects the antibody levels after SARS-CoV-2 vaccination in patients with CKD G4/5, dialysis patients and KTR. mRNA-1273 vaccine induces a higher antibody level and higher frequency of adverse events.
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Affiliation(s)
- Pim Bouwmans
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, University of Maastricht, Maastricht, The Netherlands
| | - A Lianne Messchendorp
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Céline Imhof
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan-Stephan F Sanders
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Luuk B Hilbrands
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marlies E J Reinders
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC Transplant Institute, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Priya Vart
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
| | - Frederike J Bemelman
- Amsterdam UMC Location University of Amsterdam, Renal Transplant Unit, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, The Netherlands
| | - Alferso C Abrahams
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Marc A G J Ten Dam
- Department of Internal Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Aiko P J de Vries
- Department of Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
- Leiden Transplant Center, Leiden, The Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands
- Landsteiner Laboratory, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Maurice Steenhuis
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands
- Landsteiner Laboratory, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ron T Gansevoort
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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41
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Kodali L, Budhiraja P, Gea-Banacloche J. COVID-19 in kidney transplantation-implications for immunosuppression and vaccination. Front Med (Lausanne) 2022; 9:1060265. [PMID: 36507509 PMCID: PMC9727141 DOI: 10.3389/fmed.2022.1060265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/09/2022] [Indexed: 11/24/2022] Open
Abstract
COVID-19 pandemic continues to challenge the transplant community, given increased morbidity and mortality associated with the disease and poor response to prevention measures such as vaccination. Transplant recipients have a diminished response to both mRNA and vector-based vaccines compared to dialysis and the general population. The currently available assays to measure response to vaccination includes commercially available antibody assays for anti-Spike Ab, or anti- Receptor Binding Domain Ab. Positive antibody testing on the assays does not always correlate with neutralizing antibodies unless the antibody levels are high. Vaccinations help with boosting polyfunctional CD4+ T cell response, which continues to improve with subsequent booster doses. Ongoing efforts to improve vaccine response by using additional booster doses and heterologous vaccine combinations are underway. There is improved antibody response in moderate responders; however, the ones with poor response to initial vaccination doses, continue to have a poor response to sequential boosters. Factors associated with poor vaccine response include diabetes, older age, specific immunosuppressants such as belatacept, and high dose mycophenolate. In poor responders, a decrease in immunosuppression can increase response to vaccination. COVID infection or vaccination has not been associated with an increased risk of rejection. Pre- and Post-exposure monoclonal antibodies are available to provide further protection against COVID infection, especially in poor vaccine responders. However, the efficacy is challenged by the emergence of new viral strains. A recently approved bivalent vaccine offers better protection against the Omicron variant.
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Affiliation(s)
- Lavanya Kodali
- Department of Internal Medicine, Mayo Clinic, Phoenix, AZ, United States
- Division of Nephrology, Transplant Center, Mayo Clinic, Phoenix, AZ, United States
| | - Pooja Budhiraja
- Department of Internal Medicine, Mayo Clinic, Phoenix, AZ, United States
- Division of Nephrology, Transplant Center, Mayo Clinic, Phoenix, AZ, United States
| | - Juan Gea-Banacloche
- Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, MD, United States
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42
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Stich M, Di Cristanziano V, Tönshoff B, Weber LT, Dötsch J, Rammer MT, Rieger S, Heger E, Garbade SF, Burgmaier K, Benning L, Speer C, Habbig S, Haumann S. Humoral immune response and live-virus neutralization of the SARS-CoV-2 omicron (BA.1) variant after COVID-19 mRNA vaccination in children and young adults with chronic kidney disease. Pediatr Nephrol 2022; 38:1935-1948. [PMID: 36409368 PMCID: PMC9684918 DOI: 10.1007/s00467-022-05806-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Data on humoral immune response to standard COVID-19 vaccination are scarce in adolescent patients and lacking for children below 12 years of age with chronic kidney disease including kidney transplant recipients. METHODS We therefore investigated in this retrospective two-center study (DRKS00024668; registered 23.03.2021) the humoral immune response to a standard two-dose mRNA vaccine regimen in 123 CKD patients aged 5-30 years. A live-virus assay was used to assess the serum neutralizing activity against the SARS-CoV-2 omicron (BA.1) variant. RESULTS Children aged 5-11 years had a comparable rate and degree of immune response to adolescents despite lower vaccine doses (10 µg vs. 30 µg BNT162b2). Treatment with two (odds ratio 9.24) or three or more (odds ratio 17.07) immunosuppressants was an independent risk factor for nonresponse. The immune response differed significantly among three patient cohorts: 48 of 77 (62.3%) kidney transplant recipients, 21 of 26 (80.8%) patients on immunosuppressive therapy, and 19 of 20 (95.0%) patients with chronic kidney disease without immunosuppressive therapy responded. In the kidney transplant recipients, immunosuppressive regimens comprising mycophenolate mofetil, an eGFR of < 60 mL/min/1.73 m2, and female sex were independent risk factors for nonresponse. Two of 18 (11.1%) and 8 of 16 (50.0%) patients with an anti-S1-RBD IgG of 100-1411 and > 1411 BAU/mL, respectively, showed a neutralization activity against the omicron variant. CONCLUSION A standard mRNA vaccine regimen in immunosuppressed children and adolescents with kidney disease elicits an attenuated humoral immune response with effective live virus neutralization against the omicron variant in approximately 10% of the patients, underlying the need for omicron-adapted vaccination. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Maximilian Stich
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Veronica Di Cristanziano
- Institute of Virology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Lutz Thorsten Weber
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Jörg Dötsch
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Marian Theodor Rammer
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Susanne Rieger
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Eva Heger
- Institute of Virology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Sven F Garbade
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Kathrin Burgmaier
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
- Faculty of Applied Healthcare Science, Deggendorf Institute of Technology, Deggendorf, Germany
| | - Louise Benning
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Claudius Speer
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Sandra Habbig
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany.
| | - Sophie Haumann
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
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43
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Theocharidou E, Adebayo D. Challenges in liver transplantation in the context of a major pandemic. World J Transplant 2022; 12:347-358. [PMID: 36437846 PMCID: PMC9693897 DOI: 10.5500/wjt.v12.i11.347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/27/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022] Open
Abstract
Coronavirus disease-2019 (COVID-19) has led to a temporary suspension of liver transplant activity across the world and the remodeling of care for patients on the waiting list and transplant recipients with the increasing use of remote consultations. Emerging evidence shows that patients with more advanced liver disease are at increased risk of severe COVID-19 and death, whereas transplant recipients have similar risk with the general population which is mainly driven by age and metabolic comorbidities. Tacrolimus immunosuppression might have a protective role in the post-transplant population. Vaccines that have become rapidly available seem to be safe in liver patients, but the antibody response in transplant patients is likely suboptimal. Most transplant centers were gradually able to resume activity soon after the onset of the pandemic and after modifying their pathways to optimize safety for patients and workforce. Preliminary evidence regarding utilizing grafts from positive donors and/or transplanting recently recovered or infected recipients under certain circumstances is encouraging and may allow offering life-saving transplant to patients at the greatest need. This review summarizes the currently available data on liver transplantation in the context of a major pandemic and discusses areas of uncertainty and future challenges. Lessons learnt from the COVID-19 pandemic might provide invaluable guidance for future pandemics.
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Affiliation(s)
- Eleni Theocharidou
- 2nd Department of Internal Medicine, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642, Thessaloniki, Greece
| | - Danielle Adebayo
- Department of Gastroenterology and Hepatology, Royal Berkshire NHS Foundation Trust, London Road, Reading, RG1 5AN, United Kingdom
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44
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What Is New in Prophylaxis and Treatment of COVID-19 in Renal Transplant Patients? A Report from an ESOT Meeting on the Topic. TRANSPLANTOLOGY 2022. [DOI: 10.3390/transplantology3040030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
I should highlight that this manuscript is not a formal review on the topic, but a report from an ESOT meeting held on 22 June 2022. The assumption of immunosuppressants exposes kidney transplant recipients to the risk of infections, including COVID-19 infection. A transplant patient having COVID-19 infection raises several questions, including whether the immunosuppressive therapy should be reduced with the consequent risk of favoring acute rejections. Patient vaccination before transplantation is probably the gold standard to avoid the risk of COVID-19 infection after transplantation. In the case of transplant patients, three measures may be undertaken: vaccination, use of monoclonal antibodies and use of therapeutic antiviral small molecules. Concerning vaccination, it is still debated which one is the best and how many doses should be administered, particularly considering the new variants of the virus. The onset of virus variants has stimulated researchers to find new active vaccines. In addition, not all transplant patients develop antibodies. An alternative prophylactic measure to be principally used for patients that do not develop antibodies after vaccination is the use of monoclonal antibodies. These drugs may be administered as prophylaxis or in the early stage of the disease. Finally, the small antiviral molecules may be used again as prophylaxis or treatment. Their major drawbacks are their interference with immunosuppressive drugs and the fact that some of them cannot be administered to patients with low eGFR.
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45
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SARS-CoV-2 Vaccination in Kidney Transplant Recipients—Stratified Analysis of the Humoral Immune Response. Transplant Direct 2022; 8:e1384. [PMID: 36259077 PMCID: PMC9575732 DOI: 10.1097/txd.0000000000001384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 11/26/2022] Open
Abstract
Kidney transplant recipients are at increased risk of SARS-CoV-2 infection and a more severe course of COVID-19.
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46
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Thümmler L, Konik M, Lindemann M, Fisenkci N, Koldehoff M, Gäckler A, Horn PA, Theodoropoulos F, Taube C, Zettler M, Anastasiou OE, Braß P, Jansen S, Witzke O, Rohn H, Krawczyk A. Long-term cellular immune response in immunocompromised unvaccinated COVID-19 patients undergoing monoclonal antibody treatment. Front Immunol 2022; 13:980698. [PMID: 36311723 PMCID: PMC9606643 DOI: 10.3389/fimmu.2022.980698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/26/2022] [Indexed: 11/17/2022] Open
Abstract
Immunocompromised patients are at increased risk for a severe course of COVID-19. Treatment of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection with anti-SARS-CoV-2 monoclonal antibodies (mAbs) has become widely accepted. However, the effects of mAb treatment on the long-term primary cellular response to SARS-CoV-2 are unknown. In the following study, we investigated the long-term cellular immune responses to SARS-CoV-2 Spike S1, Membrane (M) and Nucleocapsid (N) antigens using the ELISpot assay in unvaccinated, mAb-treated immunocompromised high-risk patients. Anti-SARS-CoV-2 mAb untreated though vaccinated COVID-19 immunocompromised patients, vaccinated SARS-CoV-2 immunocompromised patients without COVID-19 and vaccinated healthy control subjects served as control groups. The cellular immune response was determined at a median of 5 months after SARS-CoV-2 infection. Our data suggest that immunocompromised patients develop an endogenous long-term cellular immune response after COVID-19, although at low levels. A better understanding of the cellular immune response will help guide clinical decision making for these vulnerable patient cohorts.
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Affiliation(s)
- Laura Thümmler
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Medicine Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Institute for Transfusion Medicine, University Medicine Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Margarethe Konik
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Medicine Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Monika Lindemann
- Institute for Transfusion Medicine, University Medicine Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Neslinur Fisenkci
- Institute for Transfusion Medicine, University Medicine Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Michael Koldehoff
- Department of Hematology and Stem Cell Transplantation, University Medicine Essen, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Hygiene and Environmental Medicine, University Medicine Essen, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Anja Gäckler
- Department of Nephrology, University Medicine Essen, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Peter A. Horn
- Institute for Transfusion Medicine, University Medicine Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Fotis Theodoropoulos
- Department of Pneumology, University Medicine Essen-Ruhrlandklinik, University Duisburg- Essen, Essen, Germany
| | - Christian Taube
- Department of Pneumology, University Medicine Essen-Ruhrlandklinik, University Duisburg- Essen, Essen, Germany
| | - Markus Zettler
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Medicine Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Olympia Evdoxia Anastasiou
- Institute for Virology, University Medicine Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Peer Braß
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Medicine Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Sarah Jansen
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Medicine Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Medicine Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Hana Rohn
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Medicine Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- *Correspondence: Adalbert Krawczyk, ; Hana Rohn,
| | - Adalbert Krawczyk
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Medicine Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Institute for Virology, University Medicine Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- *Correspondence: Adalbert Krawczyk, ; Hana Rohn,
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Becker M, Cossmann A, Lürken K, Junker D, Gruber J, Juengling J, Ramos GM, Beigel A, Wrenger E, Lonnemann G, Stankov MV, Dopfer-Jablonka A, Kaiser PD, Traenkle B, Rothbauer U, Krause G, Schneiderhan-Marra N, Strengert M, Dulovic A, Behrens GMN. Longitudinal cellular and humoral immune responses after triple BNT162b2 and fourth full-dose mRNA-1273 vaccination in haemodialysis patients. Front Immunol 2022; 13:1004045. [PMID: 36275672 PMCID: PMC9582343 DOI: 10.3389/fimmu.2022.1004045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/12/2022] [Indexed: 11/30/2022] Open
Abstract
Haemodialysis patients respond poorly to vaccination and continue to be at-risk for severe COVID-19. Therefore, dialysis patients were among the first for which a fourth COVID-19 vaccination was recommended. However, targeted information on how to best maintain immune protection after SARS-CoV-2 vaccinations in at-risk groups for severe COVID-19 remains limited. We provide, to the best of our knowledge, for the first time longitudinal vaccination response data in dialysis patients and controls after a triple BNT162b2 vaccination and in the latter after a subsequent fourth full-dose of mRNA-1273. We analysed systemic and mucosal humoral IgG responses against the receptor-binding domain (RBD) and ACE2-binding inhibition towards variants of concern including Omicron and Delta with multiplex-based immunoassays. In addition, we assessed Spike S1-specific T-cell responses by interferon γ release assay. After triple BNT162b2 vaccination, anti-RBD B.1 IgG and ACE2 binding inhibition reached peak levels in dialysis patients, but remained inferior compared to controls. Whilst we detected B.1-specific ACE2 binding inhibition in 84% of dialysis patients after three BNT162b2 doses, binding inhibition towards the Omicron variant was only detectable in 38% of samples and declining to 16% before the fourth vaccination. By using mRNA-1273 as fourth dose, humoral immunity against all SARS-CoV-2 variants tested was strongly augmented with 80% of dialysis patients having Omicron-specific ACE2 binding inhibition. Modest declines in T-cell responses in dialysis patients and controls after the second vaccination were restored by the third BNT162b2 dose and significantly increased by the fourth vaccination. Our data support current advice for a four-dose COVID-19 immunisation scheme for at-risk individuals such as haemodialysis patients. We conclude that administration of a fourth full-dose of mRNA-1273 as part of a mixed mRNA vaccination scheme to boost immunity and to prevent severe COVID-19 could also be beneficial in other immune impaired individuals. Additionally, strategic application of such mixed vaccine regimens may be an immediate response against SARS-CoV-2 variants with increased immune evasion potential.
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Affiliation(s)
- Matthias Becker
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Anne Cossmann
- Department for Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Karsten Lürken
- Department of Internal Medicine and Nephrology, Dialysis Centre Eickenhof, Langenhagen, Germany
| | - Daniel Junker
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Jens Gruber
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Jennifer Juengling
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Gema Morillas Ramos
- Department for Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Andrea Beigel
- Department of Internal Medicine and Nephrology, Dialysis Centre Eickenhof, Langenhagen, Germany
| | - Eike Wrenger
- Department of Internal Medicine and Nephrology, Dialysis Centre Eickenhof, Langenhagen, Germany
| | - Gerhard Lonnemann
- Department of Internal Medicine and Nephrology, Dialysis Centre Eickenhof, Langenhagen, Germany
| | - Metodi V. Stankov
- Department for Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Alexandra Dopfer-Jablonka
- Department for Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
- German Centre for Infection Research (DZIF), partner site Hannover-Braunschweig, Hannover, Germany
| | - Philipp D. Kaiser
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Bjoern Traenkle
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Ulrich Rothbauer
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
- Pharmaceutical Biotechnology, University of Tübingen, Tübingen, Germany
| | - Gérard Krause
- German Centre for Infection Research (DZIF), partner site Hannover-Braunschweig, Hannover, Germany
- Department Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
- TWINCORE GmbH, Centre for Experimental and Clinical Infection Research, a joint venture of the Hannover Medical School and the Helmholtz Centre for Infection Research, Hannover, Germany
| | | | - Monika Strengert
- Department Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
- TWINCORE GmbH, Centre for Experimental and Clinical Infection Research, a joint venture of the Hannover Medical School and the Helmholtz Centre for Infection Research, Hannover, Germany
- *Correspondence: Monika Strengert, ; Alex Dulovic, ; Georg M. N. Behrens,
| | - Alex Dulovic
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
- *Correspondence: Monika Strengert, ; Alex Dulovic, ; Georg M. N. Behrens,
| | - Georg M. N. Behrens
- Department for Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
- German Centre for Infection Research (DZIF), partner site Hannover-Braunschweig, Hannover, Germany
- CiiM - Centre for Individualized Infection Medicine, Hannover, Germany
- *Correspondence: Monika Strengert, ; Alex Dulovic, ; Georg M. N. Behrens,
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Factors Associated With COVID-19 Vaccine Response in Transplant Recipients: A Systematic Review and Meta-analysis. Transplantation 2022; 106:2068-2075. [PMID: 35761439 PMCID: PMC9521391 DOI: 10.1097/tp.0000000000004256] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The rapid development and universal access to vaccines represent a milestone in combating the coronavirus disease 2019 (COVID-19) pandemic. However, there are major concerns about vaccine response in immunocompromised populations in particular transplant recipients. In the present study, we aim to comprehensively assess the humoral response to COVID-19 vaccination in both orthotopic organ transplant and allogeneic hematopoietic stem cell transplant recipients. METHODS We performed a systematic review and meta-analysis of 96 studies that met inclusion criteria. RESULTS The pooled rates of seroconversion were 49% (95% confidence interval [CI], 43%-55%) in transplant recipients and 99% (95% CI, 99%-99%) in healthy controls after the second dose of vaccine. The pooled rate was 56% (95% CI, 49%-63%) in transplant recipients after the third dose. Immunosuppressive medication is the most prominent risk factor associated with seroconversion failure, but different immunosuppressive regimens are associated with differential outcomes in this respect. Calcineurin inhibitors, steroids, or mycophenolate mofetil/mycophenolic acid are associated with an increased risk of seroconversion failure, whereas azathioprine or mammalian target of rapamycin inhibitors do not. Advanced age, short interval from receiving the vaccine to the time of transplantation, or comorbidities confers a higher risk for seroconversion failure. CONCLUSIONS Transplant recipients compared with the general population have much lower rates of seroconversion upon receiving COVID-19 vaccines. Immunosuppressants are the most prominent factors associated with seroconversion, although different types may have differential effects.
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Villavicencio A, Ebisu Y, Raja M, Sanchez‐Covarrubias AP, Reynolds JM, Natori Y. Adverse events after SARS-CoV-2 vaccination in solid organ transplant recipients: A systematic review. Transpl Infect Dis 2022; 24:e13936. [PMID: 36067062 PMCID: PMC9538206 DOI: 10.1111/tid.13936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/15/2022] [Indexed: 01/14/2023]
Affiliation(s)
- Aasith Villavicencio
- Division of Internal MedicineDepartment of MedicineUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Yosuke Ebisu
- Division of Infectious DiseaseDepartment of MedicineUniversity of Miami Miller School of MedicineMiamiFloridaUSA,Kameda Medical CenterChibaJapan
| | - Mohammed Raja
- Division of Infectious DiseaseDepartment of MedicineUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Alex P. Sanchez‐Covarrubias
- Division of Gynecologic OncologyDepartment of Obstetrics, Gynecology and Reproductive Sciences, University of MiamiMiller School of MedicineMiamiFloridaUSA
| | - John M. Reynolds
- Department of Health Informatics, Calder Memorial LibraryUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Yoichiro Natori
- Division of Infectious DiseaseDepartment of MedicineUniversity of Miami Miller School of MedicineMiamiFloridaUSA,Miami Transplant Institute, Jackson Health SystemMiamiFloridaUSA
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SARS-CoV-2 Vaccination in Solid-Organ Transplant Recipients. Vaccines (Basel) 2022; 10:vaccines10091430. [PMID: 36146506 PMCID: PMC9503203 DOI: 10.3390/vaccines10091430] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has posed significant global challenges for solid organ transplant (SOT) recipients. Mortality rates of COVID-19 in this patient population remain high, despite new available therapeutic options and Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) vaccination. Priority access to SARS-CoV-2 vaccination for waitlisted candidates and for SOT patients and their family members is recommended since the advantage from vaccination reduces the risk of COVID-19-related complications. However, immunogenicity and efficacy of COVID-19 vaccines are lower in waitlisted candidates and SOT recipients than in the general population. Routine systematic assessment of humoral and cellular immune responses after SARS-CoV-2 vaccination is controversial, although highly recommended for investigation and improvement of knowledge. SOT recipients should continue to adhere to preventive protective measures despite vaccination and may undergo passive antibody prophylaxis. This article seeks to provide an update on SARS-CoV-2 vaccination and preventive measures in SOT recipients based on existing literature and international guidelines.
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