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Nikaein A, Chemmalakuzhy A, Khan S, Hunt J, Haumpy D, Choudhary A, Pinter A, Sanchez A, Lerman M. Monitored COVID-19 vaccine humoral response in immunocompromised solid organ transplant recipients. Hum Immunol 2024; 85:110760. [PMID: 38310028 DOI: 10.1016/j.humimm.2024.110760] [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: 07/19/2023] [Revised: 12/28/2023] [Accepted: 01/17/2024] [Indexed: 02/05/2024]
Abstract
The SARS-CoV-2 pandemic has resulted in rapid research and vaccine development to help curtail unchecked transmission. However, these studies cannot be applied as easily among every population, such as immunocompromised individuals. In this study, we observed the humoral response of 70 total heart and renal transplant patients to mRNA SARS-CoV-2 vaccinations to help further understand the effectiveness of vaccination in post-transplant patients following second or booster vaccinations. Antibodies were measured by bead technology to detect IgG, as well as IgG/IgM Rapid Cassette tests for confirmation. Immunocompromised patients had a noticeably lower humoral response than non-immunocompromised populations, with an even lower response among Black patients. Our findings also show for the first time various antibody responses to different motifs of the virus, with the lowest being against the S2 motif. A potential link between the duration of immunosuppression and vaccine response was also observed, where patients on immunosuppressants for longer had a stronger response to vaccination compared to recent transplant patients in our study. In addition, younger transplant recipients had a better humoral response to vaccination, and vaccine effectiveness was disproportionate between races. This finding reinforces the continuation of the guidelines for accelerated vaccination schedules for immunocompromised patients.
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Affiliation(s)
- Afzal Nikaein
- Texas Medical Specialty, Inc, 7777 Forest Lane, Dallas, TX 75230, United States.
| | | | - Salman Khan
- Medical City Dallas, 7777 Forest Lane, Dallas, TX 75230, United States
| | - Judson Hunt
- Medical City Dallas, 7777 Forest Lane, Dallas, TX 75230, United States
| | - Derek Haumpy
- Texas Medical Specialty, Inc, 7777 Forest Lane, Dallas, TX 75230, United States
| | - Alok Choudhary
- Public Health Research Institute, New Jersey Medical School, Rutgers University, 185 S Orange Ave, Newark, NJ 07130, United States
| | - Abraham Pinter
- Public Health Research Institute, New Jersey Medical School, Rutgers University, 185 S Orange Ave, Newark, NJ 07130, United States
| | - Ayrton Sanchez
- Texas Medical Specialty, Inc, 7777 Forest Lane, Dallas, TX 75230, United States
| | - Mark Lerman
- Medical City Dallas, 7777 Forest Lane, Dallas, TX 75230, United States
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Luo X, Lessomo FYN, Yu Z, Xie Y. Factors influencing immunogenicity and safety of SARS-CoV-2 vaccine in liver transplantation recipients: a systematic review and meta-analysis. Front Immunol 2023; 14:1145081. [PMID: 37731498 PMCID: PMC10508849 DOI: 10.3389/fimmu.2023.1145081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 08/22/2023] [Indexed: 09/22/2023] Open
Abstract
Background This review summarizes the factors influencing the efficacy and safety of the COVID-19 vaccine in LTR through meta-analysis, hoping to provide strategies for vaccine use. Methods Electronic databases were screened for studies on mRNA vaccines in LTR. The primary outcome was the pooled seroconversion rate, and the secondary outcome was the incidence of adverse events+breakthrough infections. Subgroup analyses were made based on BMI, associated comorbidities, presence of baseline leukopenia, time since transplant, and drugs used. Result In total, 31 articles got included. The pooled seroconversion rate after at least two doses of SARS-CoV-2 vaccination was 72% (95% CI [0.52-0.91). With significant heterogeneity among studies I2 = 99.9%, the seroconversion rate was about 72% (95%CI [0.66-0.75]), from the studies reporting two doses of vaccine slightly higher around 75%(95%CI [0.29-1.22]) from studies reporting three doses. The pooled seroconversion rate within the lower to normal BMI group was 74% (95% CI [0.22-1.27], Pi=0.005) against 67% (95% CI [0.52-0.81], Pi=0.000) in the high BMI group. The pooled seroconversion rate in the ''positive leukopenia'' group was the lowest, 59%. Leukopenia could influence the vaccine seroconversion rate in LTR. From the time since transplant analysis after setting seven years as cut off point, the pooled seroconversion rate after at least two doses of COVID-19 vaccination was 53% (95% CI [0.18-0.83], P=0.003, I2 = 99.6%) in <7years group and 83% (95% CI [0.76-0.90], P=0.000 I2 = 95.7%) in > 7years group. The only time since transplantation had reached statistical significance to be considered a risk factor predictor of poor serological response (OR=1.27 95%CI [1.03-1.55], P=0.024). The breakthrough infection rate after vaccination was very low2% (95% CI 0.01-0.03, I2 = 63.0%), and the overall incidence of adverse events, which included mainly pain at the injection site and fatigue, was 18% (95%CI [0.11-0.25], I2 = 98.6%, Pi=0.000). Conclusion The seroconversion rate in LTR vaccinated with at least two doses of mRNA COVID-19 vaccine could be significantly affected by the vaccine type, immunosuppressant used, BMI, leukopenia, associated comorbidities, and time since transplantation. Nevertheless, booster doses are still recommended for LTR.
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Affiliation(s)
- Xinyi Luo
- Queen Mary School, Nanchang University, Nanchang, Jiangxi, China
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | | | - Zhimin Yu
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yong Xie
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Chiu HF, Tsai SF, Wu MJ, Yu TM, Chuang YW, Chen CH. Outcomes and Effects of Vaccination on Sars-Cov-2 Omicron Infection in Kidney Transplant Recipients. Transplant Proc 2023:S0041-1345(23)00255-5. [PMID: 37208223 DOI: 10.1016/j.transproceed.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/02/2023] [Accepted: 04/11/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Kidney transplant recipients (KTRs) are at high risk of COVID-19. Vaccination is significantly effective at preventing infection and reducing infection severity. Omicron infections are less severe than infections by previous strains, but breakthrough disease is more common. Thus, we conducted this study to observe the vaccine efficacy in our KTRs. METHODS During the surge in the Omicron variant, beginning in May 2022, we retrieved data from 365 KTRs who had received at least one dose of various COVID vaccines until June 30, 2022. Outcomes of the KTRs (n = 168) after at least the 2nd vaccination were assessed until September 30, 2022, before the border was opened for tourism. RESULTS The antibody response in KTRs after the 1st and 2nd doses of SARS-CoV-2 vaccines demonstrated a significant increase from the 1st dose (median: 0.4; IQR: 0.4-8.4 U/mL, P < .001) to the 2nd dose (median: 57.5; IQR: 0.4-799.2 U/mL), and the response rate rose from 32% to 65% (P < .001). SARS-CoV-2 infection was identified in 14/365 (3.8%) patients after at least the 1st dose and 7/187 (3.7%) patients at least 7 days beyond the 2nd dose. Most KTRs had a mild course, but 3 (17%) were hospitalized due to pneumonia. CONCLUSIONS Our data demonstrate a lower response rate and anti-S titers after 2nd dose vaccination in KTRs than in the general population, but a lower incidence of SARS-CoV-2 infection after vaccination was observed during the Omicron outbreak. Owing to the breakthrough infections found in ordinarily vaccinated KTRs, we must emphasize the importance of vaccination and boosters to prevent severe illness, hospitalizations, and death among those developing infections.
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Affiliation(s)
- Hsien-Fu Chiu
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Life Science, Tunghai University, Taichung, Taiwan
| | - Shang-Feng Tsai
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan; Department of Life Science, Tunghai University, Taichung, Taiwan
| | - Ming-Ju Wu
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Tung-Min Yu
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Ya-Wen Chuang
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Cheng-Hsu Chen
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan; Department of Life Science, Tunghai University, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan.
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Sandoval M, Nguyen DT, Huang HJ, Yi SG, Ghobrial RM, Gaber AO, Graviss EA. COVID-19 mortality may be reduced among fully vaccinated solid organ transplant recipients. PLoS One 2022; 17:e0279222. [PMID: 36542654 PMCID: PMC9770372 DOI: 10.1371/journal.pone.0279222] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/03/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Solid organ transplant (SOT) recipients are at increased risk for morbidity and mortality from COVID-19 due to their immunosuppressed state and reduced immunogenicity from COVID-19 mRNA vaccines. This investigation examined the association between COVID-19 mRNA vaccination status and mortality among SOT recipients diagnosed with COVID-19. METHODS & FINDINGS A retrospective, registry-based chart review was conducted investigating COVID-19 mortality among immunosuppressed solid organ transplant (SOT) recipients in a large metropolitan healthcare system in Houston, Texas, USA. Electronic health record data was collected from consecutive SOT recipients who received a diagnostic SARS-CoV-2 test between March 1, 2020, and October 1, 2021. The primary exposure was COVID-19 vaccination status at time of COVID-19 diagnosis. Patients were considered 'fully vaccinated' at fourteen days after completing their vaccine course. COVID-19 mortality within 60 days and intensive care unit admission within 30 days were primary and secondary endpoints, respectively. Among 646 SOT recipients who were diagnosed with COVID-19 at Houston Methodist Hospital between March 2020, and October 2021, 70 (10.8%) expired from COVID-19 within 60 days. Transplanted organs included 63 (9.8%) heart, 355 (55.0%) kidney, 108 (16.7%) liver, 70 (10.8%) lung, and 50 (7.7%) multi-organ. Increasing age was a risk factor for COVID-19 mortality, while vaccination within 180 days of COVID-19 diagnosis was protective in Cox proportional hazard models with hazard ratio 1.04 (95% CI: 1.01-1.06) and 0.31 (0.11-0.90), respectively). These findings were confirmed in the propensity score matched cohort between vaccinated and unvaccinated patients. CONCLUSIONS This investigation found COVID-19 mortality may be significantly reduced among immunosuppressed SOT recipients within 6 months following vaccination. These findings can inform vaccination policies targeting immunosuppressed populations worldwide.
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Affiliation(s)
- Micaela Sandoval
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, TX, United States of America
- Department of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas Health Science Center School of Public Health, Houston, TX, United States of America
| | - Duc T. Nguyen
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, TX, United States of America
| | - Howard J. Huang
- J.C. Walter Jr Transplant Center, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, United States of America
- Department of Medicine, Houston Methodist Hospital, Houston, TX, United States of America
| | - Stephanie G. Yi
- J.C. Walter Jr Transplant Center, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, United States of America
- Department of Surgery, Houston Methodist Hospital, Houston, TX, United States of America
| | - R. Mark Ghobrial
- J.C. Walter Jr Transplant Center, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, United States of America
- Department of Surgery, Houston Methodist Hospital, Houston, TX, United States of America
| | - A. Osama Gaber
- J.C. Walter Jr Transplant Center, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, United States of America
- Department of Surgery, Houston Methodist Hospital, Houston, TX, United States of America
| | - Edward A. Graviss
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, TX, United States of America
- Department of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas Health Science Center School of Public Health, Houston, TX, United States of America
- Department of Surgery, Houston Methodist Hospital, Houston, TX, United States of America
- * E-mail:
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Zhang X, Weng R, Liu F, Xie Y, Jin Y, Li Q, Huang G, Chen J, Wang J, Shen H, Fu H, Mao J. COVID-19 Breakthrough Infections in Vaccinated Kidney Transplant Recipients. Vaccines (Basel) 2022; 10:vaccines10111911. [PMID: 36423007 PMCID: PMC9696595 DOI: 10.3390/vaccines10111911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/07/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is associated with increased morbidity and mortality among kidney transplant recipients (KTRs). The administration of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination is the only reliable strategy to prevent COVID-19 and alleviate the severity of COVID-19 in this particular population. The aim of this article was to evaluate the clinical protection by vaccines (breakthrough infections, deaths, and hospitalizations) in KTRs. There were 135 KTRs with COVID-19 breakthrough infections for whom patient-level data were available in PubMed and Web of Science. There was a male predominance (61.4%), 97 were given the standard vaccination regimen, and 38 received three or four doses of the vaccine. The median age was 59.0 (IQR: 49.0−69.0) years. A total of 67 patients were hospitalized, and 10 patients died. In 72.6% of cases, triple-maintenance immunosuppression was employed. The deceased patients were older than the survivors (p < 0.05); an age over 60 years was a risk factor for death (p < 0.05). The KTRs with booster vaccines had a longer time interval from the last vaccine to COVID-19 infection and lower hospitalization rates than the individuals who received the standard vaccination regimen (33.3% vs. 54.8%, p < 0.05). The hospitalized patients were older than the outpatients (p < 0.05). Among 16,820 fully vaccinated or boosted KTRs from 14 centers, there were 633 breakthrough infections (3.58%) and 73 associated deaths (0.41%). The center-level breakthrough infection rates varied from 0.21% to 9.29%. These findings highlight the need for booster doses for KTRs. However, more research is needed to define the long-term effectiveness and immunogenicity of booster doses and to identify methods to boost the protective response to vaccination in these immunocompromised patients.
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Affiliation(s)
- Xiaojing Zhang
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Ruopeng Weng
- Department of Gynecology and Obstetrics, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310007, China
| | - Fei Liu
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Yi Xie
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Yanyan Jin
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Qiuyu Li
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Guoping Huang
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Junyi Chen
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Jingjing Wang
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Huijun Shen
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Haidong Fu
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Jianhua Mao
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
- Correspondence:
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SPIRITO F, CAPONIO VC, MAZZOCCOLI G, LO MUZIO L. Monoclonal antibodies and oral pills for COVID-19: new possibilities for solid organ transplanted patients? Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.22.05495-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kleiboeker HL, Jorgenson MR, Smith JA. Myalgia in liver transplant recipients after receiving tixagevimab/cilgavimab for pre-exposure prophylaxis of COVID-19: A case series. Transpl Infect Dis 2022; 24:e13932. [PMID: 35980219 PMCID: PMC9538891 DOI: 10.1111/tid.13932] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/15/2022] [Indexed: 01/14/2023]
Affiliation(s)
- Hanna L. Kleiboeker
- Department of PharmacyUniversity of Wisconsin Hospital and ClinicsMadisonWisconsinUSA
| | - Margaret R. Jorgenson
- Department of PharmacyUniversity of Wisconsin Hospital and ClinicsMadisonWisconsinUSA
| | - Jeannina A. Smith
- Department of MedicineDivision of Infectious DiseasesUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
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Hall VG, Al-Alahmadi G, Solera JT, Marinelli T, Cardinal H, Prasad GVR, De Serres SA, Isaac D, Mainra R, Lamarche C, Sapir-Pichhadze R, Gilmour S, Matelski J, Humar A, Kumar D. Outcomes of SARS-CoV-2 Infection in Unvaccinated Compared With Vaccinated Solid Organ Transplant Recipients: A Propensity Matched Cohort Study. Transplantation 2022; 106:1622-1628. [PMID: 35502801 PMCID: PMC9311277 DOI: 10.1097/tp.0000000000004178] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/17/2022] [Accepted: 04/01/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Solid organ transplant (SOT) recipients are at high risk for complications from coronavirus disease 2019 (COVID-19). Vaccination may mitigate this risk; however, immunogenicity appears to be significantly impaired, with reports of increased risk of breakthrough infection. It is unknown if vaccine breakthrough infections are milder or as severe as infections in unvaccinated patients. METHODS We performed a multicenter matched cohort study between March 2020 and September 2021 to assess influence of COVID-19 vaccination on outcomes of COVID-19 infection. Treatment characteristics and disease severity outcomes were compared on the basis of vaccine status; breakthrough infections versus unvaccinated infections. Variable ratio propensity score matching based on age, sex, transplant type, and number of comorbidities, was used to develop the analytic cohort. Logistic regression was used to assess the influence of vaccination status on the selected outcomes. RESULTS From a cohort of 511 SOT patients with COVID-19, we matched 77 partially or fully vaccinated patients with 220 unvaccinated patients. Treatment characteristics including use of dexamethasone, remdesivir, and antibiotics did not differ. Vaccinated participants were more likely to receive tocilizumab, 15 of 77 (19.5%) versus 5 of 220 (2.3%), P < 0.001. Disease severity outcomes including oxygen requirement, mechanical ventilation, and mortality were similar among medically attended vaccine breakthroughs compared with unvaccinated patients. CONCLUSIONS SOT recipients who develop medically attended COVID-19 following 1- or 2-dose vaccination seem to have similar disease severity to unvaccinated patients who develop infection. This is consistent with the requirement that SOT recipients need 3 or more vaccine doses and emphasizes the importance of alternate strategies for this population.
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Affiliation(s)
- Victoria G. Hall
- Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Ghadeer Al-Alahmadi
- Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Javier T. Solera
- Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Tina Marinelli
- Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
- Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Heloise Cardinal
- Department of Medicine, University of Montreal, Montreal, QC, Canada
| | - G. V. Ramesh Prasad
- Kidney Transplant Program, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Sacha A. De Serres
- Transplantation Unit, Renal Division, Department of Medicine, University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Debra Isaac
- Division of Transplant Medicine, University of Calgary, Calgary, AB, Canada
| | - Rahul Mainra
- Saskatchewan Transplant Program, Transplantation Unit, Renal Division, Department of Medicine, University Health Center of Saskatchewan, Saskatoon, SK, Canada
| | - Caroline Lamarche
- Hôpital Maisonneuve-Rosemont Research Institute, Université de Montréal, Montréal, QC, Canada
| | - Ruth Sapir-Pichhadze
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, QC, Canada
- Division of Nephrology, Department of Medicine, McGill University, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics, Occupational Health, McGill University, Montreal, QC, Canada
| | - Susan Gilmour
- Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada
| | - John Matelski
- Biostatistics Research Unit, University Health Network, Toronto, ON, Canada
| | - Atul Humar
- Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Deepali Kumar
- Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
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Cuadrado A, Del Barrio M, Fortea JI, Amigo L, San Segundo D, Rodriguez-Cundin MP, Rebollo MH, Fernandez-Santiago R, Castillo F, Achalandabaso M, Echeverri J, Anderson EJ, Rodríguez-Sanjuan JC, López-Hoyos M, Crespo J, Fábrega E. Antibody response to the messenger RNA-1273 vaccine (Moderna) in liver transplant recipients. Hepatol Commun 2022; 6:1673-1679. [PMID: 35344281 PMCID: PMC9110949 DOI: 10.1002/hep4.1937] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/17/2022] [Accepted: 02/17/2022] [Indexed: 01/05/2023] Open
Abstract
Different reports have shown the clinical and serologic response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) messenger RNA (mRNA) vaccines in preventing coronavirus disease 2019 (COVID-19) in the general population, but few studies have examined these responses in transplant recipients. We assessed the vaccine immunogenicity of two doses (100 μg) of the mRNA-1273 vaccine (Moderna) administered with a 28-day interval in liver transplant recipients (LTRs) at follow-up at the Marques de Valdecilla University Hospital. LTRs without a history of COVID-19 infection were tested for SARS-CoV-2 immunoglobulin G (IgG) antibodies directed against the spike protein (S) a median of 43 days after receiving the second Moderna vaccine dose. Clinical data, including immunosuppressive regimen and routine laboratory data, were obtained from the medical record of each patient up to 3 months before the date of the first vaccination. Factors associated with serologic response were evaluated through logistic regression. In total, 129 LTRs who had anti-S results were included. Most patients were men (n = 99; 76.7%) with a median age of 63 years (interquartile range, 56-68). Alcohol (43.4%) and chronic hepatitis C (18.6%) were the most frequent causes of liver transplantation. A positive anti-S IgG response was observed in 113 LTRs (87.6%; 95% confidence interval [CI], 80.8-92.2). A strong inverse relationship between mycophenolate mofetil use and serologic response was found (odds ratio, 0.07; 95% CI, 0.02-0.26; p = 0.001). Conclusion: Most LTRs develop an immunological response to the Moderna SARS-CoV-2 mRNA-based vaccine. An immunosuppressive regimen that includes mycophenolate predicts a weak serologic response.
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Affiliation(s)
- Antonio Cuadrado
- Department of Gastroenterology and HepatologyMarqués de Valdecilla University HospitalSantanderSpain.,Clinical and Translational Digestive Research GroupUniversity of CantabriaInstituto de investigación sanitaria Valdecilla (IDIVAL)SantanderSpain
| | - María Del Barrio
- Department of Gastroenterology and HepatologyMarqués de Valdecilla University HospitalSantanderSpain.,Clinical and Translational Digestive Research GroupUniversity of CantabriaInstituto de investigación sanitaria Valdecilla (IDIVAL)SantanderSpain
| | - José Ignacio Fortea
- Department of Gastroenterology and HepatologyMarqués de Valdecilla University HospitalSantanderSpain.,Clinical and Translational Digestive Research GroupUniversity of CantabriaInstituto de investigación sanitaria Valdecilla (IDIVAL)SantanderSpain
| | - Lidia Amigo
- Department of Gastroenterology and HepatologyMarqués de Valdecilla University HospitalSantanderSpain.,Clinical and Translational Digestive Research GroupUniversity of CantabriaInstituto de investigación sanitaria Valdecilla (IDIVAL)SantanderSpain
| | - David San Segundo
- Department of ImmunologyMarqués de Valdecilla University HospitalIDIVALSantanderSpain
| | | | - María Henar Rebollo
- Department of Preventive MedicineMarqués de Valdecilla University HospitalCantabriaSpain
| | - Roberto Fernandez-Santiago
- Department of General SurgeryMarqués de Valdecilla University HospitalSantanderSpain.,IDIVALSchool of MedicineUniversity of CantabriaSantanderSpain
| | - Federico Castillo
- Department of General SurgeryMarqués de Valdecilla University HospitalSantanderSpain.,IDIVALSchool of MedicineUniversity of CantabriaSantanderSpain
| | - Maria Achalandabaso
- Department of General SurgeryMarqués de Valdecilla University HospitalSantanderSpain.,IDIVALSchool of MedicineUniversity of CantabriaSantanderSpain
| | - Juan Echeverri
- Department of General SurgeryMarqués de Valdecilla University HospitalSantanderSpain.,IDIVALSchool of MedicineUniversity of CantabriaSantanderSpain
| | - Edward J Anderson
- Department of General SurgeryMarqués de Valdecilla University HospitalSantanderSpain.,IDIVALSchool of MedicineUniversity of CantabriaSantanderSpain
| | - Juan Carlos Rodríguez-Sanjuan
- Department of General SurgeryMarqués de Valdecilla University HospitalSantanderSpain.,IDIVALSchool of MedicineUniversity of CantabriaSantanderSpain
| | - Marcos López-Hoyos
- Department of ImmunologyMarqués de Valdecilla University HospitalIDIVALSantanderSpain
| | - Javier Crespo
- Department of Gastroenterology and HepatologyMarqués de Valdecilla University HospitalSantanderSpain.,Clinical and Translational Digestive Research GroupUniversity of CantabriaInstituto de investigación sanitaria Valdecilla (IDIVAL)SantanderSpain
| | - Emilio Fábrega
- Department of Gastroenterology and HepatologyMarqués de Valdecilla University HospitalSantanderSpain.,Clinical and Translational Digestive Research GroupUniversity of CantabriaInstituto de investigación sanitaria Valdecilla (IDIVAL)SantanderSpain
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Mazuecos A, Villanego F, Zarraga S, López V, Oppenheimer F, Llinàs-Mallol L, Hernández AM, Rivas A, Ruiz-Fuentes MC, Toapanta NG, Jiménez C, Cabello S, Beneyto I, Aladrén MJ, Rodríguez-Benot A, Canal C, Molina M, Pérez-Flores I, Saura IM, Gavela E, Franco A, Lorenzo I, Galeano C, Tabernero G, Pérez-Tamajón L, Martín-Moreno PL, Fernández-Girón F, Siverio O, Labrador PJ, De Arriba G, Simal F, Cruzado L, Moina I, Alcalde G, Sánchez-Álvarez E, Pascual J, Crespo M. Breakthrough Infections Following mRNA SARS-CoV-2 Vaccination in Kidney Transplant Recipients. Transplantation 2022; 106:1430-1439. [PMID: 35384924 PMCID: PMC9213063 DOI: 10.1097/tp.0000000000004119] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The clinical effectiveness of coronavirus disease 2019 (COVID-19) vaccination in kidney transplant (KT) recipients is lower than in the general population. METHODS From April to October 2021, 481 KT recipients with COVID-19, included in the Spanish Society of Nephrology COVID-19 Registry, were analyzed. Data regarding vaccination status and vaccine type were collected, and outcomes of unvaccinated or partially vaccinated patients (n = 130) were compared with fully vaccinated patients (n = 351). RESULTS Clinical picture was similar and survival analysis showed no differences between groups: 21.7% of fully vaccinated patients and 20.8% of unvaccinated or partially vaccinated died (P = 0.776). In multivariable analysis, age and pneumonia were independent risk factors for death, whereas vaccination status was not related to mortality. These results remained similar when we excluded patients with partial vaccination, as well as when we analyzed exclusively hospitalized patients. Patients vaccinated with mRNA-1273 (n = 213) showed a significantly lower mortality than those who received the BNT162b2 vaccine (n = 121) (hazard ratio: 0.52; 95% confidence interval, 0.31-0.85; P = 0.010). CONCLUSIONS COVID-19 severity in KT patients has remained high and has not improved despite receiving 2 doses of the mRNA vaccine. The mRNA-1273 vaccine shows higher clinical effectiveness than BNT162b2 in KT recipients with breakthrough infections. Confirmation of these data will require further research taking into account the new variants and the administration of successive vaccine doses.
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Affiliation(s)
| | | | - Sofía Zarraga
- Department of Nephrology, Hospital Universitario de Cruces, Bilbao, Spain
| | - Verónica López
- Department of Nephrology, Hospital Regional Universitario de Málaga, Universidad de Málaga, IBIMA, REDinREN (RD16/0009/0006), Málaga, Spain
| | | | - Laura Llinàs-Mallol
- Department of Nephrology, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), REDinREN (RD16/0009/0013), Barcelona, Spain
| | - Ana M. Hernández
- Department of Nephrology, Hospital Universitario Doce de Octubre, Institute i+12 for Medical Research, Madrid, Spain
| | - Alba Rivas
- Department of Nephrology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - María C. Ruiz-Fuentes
- Department of Nephrology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - Carlos Jiménez
- Department of Nephrology, Hospital Universitario La Paz, Madrid, Spain
| | - Sheila Cabello
- Department of Nephrology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Isabel Beneyto
- Department of Nephrology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - María J. Aladrén
- Department of Nephrology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Alberto Rodríguez-Benot
- Department of Nephrology, Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Cristina Canal
- Department of Nephrology, Fundació Puigvert, Barcelona, Spain
| | - María Molina
- Department of Nephrology, Hospital Universitario Germans Trias i Pujol (HUGTiP) & REMAR-IGTP Group, Germans Trias i Pujol Research Institute (IGTP), Can Ruti Campus, Barcelona, Spain
| | | | - Isabel M. Saura
- Department of Nephrology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Eva Gavela
- Department of Nephrology, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Antonio Franco
- Department of Nephrology, Hospital General Universitario de Alicante, Alicante, Spain
| | - Inmaculada Lorenzo
- Department of Nephrology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Cristina Galeano
- Department of Nephrology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Guadalupe Tabernero
- Department of Nephrology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Lourdes Pérez-Tamajón
- Department of Nephrology, Complejo Hospitalario Universitario de Canarias, La Laguna, Spain
| | | | | | - Orlando Siverio
- Department of Nephrology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Pedro J. Labrador
- Department of Nephrology, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Gabriel De Arriba
- Department of Nephrology, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Fernando Simal
- Department of Nephrology, Hospital Universitario El Bierzo, Ponferrada, Spain
| | - Leónidas Cruzado
- Department of Nephrology, Hospital General Universitario de Elche, Elche, Spain
| | - Inigo Moina
- Department of Nephrology, Hospital Universitario de Basurto, Bilbao, Spain
| | - Guillermo Alcalde
- Department of Nephrology, Hospital Universitario de Araba, Araba, Spain
| | | | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), REDinREN (RD16/0009/0013), Barcelona, Spain
- Department of Nephrology, Hospital Universitario Doce de Octubre, Institute i+12 for Medical Research, Madrid, Spain
| | - Marta Crespo
- Department of Nephrology, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), REDinREN (RD16/0009/0013), Barcelona, Spain
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11
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The effect of COVID 19 vaccination on kidney recipients. Transpl Immunol 2022; 74:101658. [PMID: 35777613 PMCID: PMC9238056 DOI: 10.1016/j.trim.2022.101658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/25/2022] [Accepted: 06/25/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Nearly one year from the onset of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, safe and effective vaccines began distribution around the world. This study aimed to assess the rate of COVID-19 disease among vaccinated kidney transplant patients and the types of symptoms found within them. DESIGN This cross-sectional study was performed at the transplant ward and Organ Procurement Unit of Sina Hospital, Tehran, Iran. As a sample size, 159 cadavers' kidney recipients received two doses of the Sinopharm SARS-CoV-2 vaccine. The required data were collected using a checklist via conducting a face-to-face interview. RESULTS The mean age of the vaccinated participants was 49.44 ± 13.87 years old. There were 73 (45.91%) vaccinated cases of SARS-CoV-2 infection during the study period, 18 cases (12.6%) occurred among fully vaccinated individuals, and 53 cases (33.3%) were among individuals who had received only one dose of vaccine. 45% of the fully vaccinated patients (received 2 doses vaccine) contracted SARS-CoV-2 from their families; 35% were infected through participation in social events (35%). There was a significant difference in disease severity levels between the fully vaccinated group and the one-dose vaccinated (p < 0.023). The severe disease occurred in 2 patients after vaccination, who were subsequently admitted to the hospital. There was a significant difference between the number of kidney transplant days and infection with SARS-CoV-2 before (P = 0.15) and after vaccination (p < 0.015). CONCLUSION Even after vaccination, kidney recipients are still at the risk of contracting SARS-CoV-2. In addition to these results, the efficacy of vaccination in preventing death caused by SARS-CoV-2 was confirmed.
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12
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Peter L, Wendering DJ, Schlickeiser S, Hoffmann H, Noster R, Wagner DL, Zarrinrad G, Münch S, Picht S, Schulenberg S, Moradian H, Mashreghi MF, Klein O, Gossen M, Roch T, Babel N, Reinke P, Volk HD, Amini L, Schmueck-Henneresse M. Tacrolimus-resistant SARS-CoV-2-specific T cell products to prevent and treat severe COVID-19 in immunosuppressed patients. Mol Ther Methods Clin Dev 2022; 25:52-73. [PMID: 35252469 PMCID: PMC8882037 DOI: 10.1016/j.omtm.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/25/2022] [Indexed: 12/15/2022]
Abstract
Solid organ transplant (SOT) recipients receive therapeutic immunosuppression that compromises their immune response to infections and vaccines. For this reason, SOT patients have a high risk of developing severe coronavirus disease 2019 (COVID-19) and an increased risk of death from severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Moreover, the efficiency of immunotherapies and vaccines is reduced due to the constant immunosuppression in this patient group. Here, we propose adoptive transfer of SARS-CoV-2-specific T cells made resistant to a common immunosuppressant, tacrolimus, for optimized performance in the immunosuppressed patient. Using a ribonucleoprotein approach of CRISPR-Cas9 technology, we have generated tacrolimus-resistant SARS-CoV-2-specific T cell products from convalescent donors and demonstrate their specificity and function through characterizations at the single-cell level, including flow cytometry, single-cell RNA (scRNA) Cellular Indexing of Transcriptomes and Epitopes (CITE), and T cell receptor (TCR) sequencing analyses. Based on the promising results, we aim for clinical validation of this approach in transplant recipients. Additionally, we propose a combinatory approach with tacrolimus, to prevent an overshooting immune response manifested as bystander T cell activation in the setting of severe COVID-19 immunopathology, and tacrolimus-resistant SARS-CoV-2-specific T cell products, allowing for efficient clearance of viral infection. Our strategy has the potential to prevent severe COVID-19 courses in SOT or autoimmunity settings and to prevent immunopathology while providing viral clearance in severe non-transplant COVID-19 cases.
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Affiliation(s)
- Lena Peter
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Charitéplatz 1, 10117 Berlin, Germany.,Einstein Center for Regenerative Therapies at Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Désirée Jacqueline Wendering
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Charitéplatz 1, 10117 Berlin, Germany
| | - Stephan Schlickeiser
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Charitéplatz 1, 10117 Berlin, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Institute of Medical Immunology, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Henrike Hoffmann
- Berlin Center for Advanced Therapies (BeCAT) at Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Rebecca Noster
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Charitéplatz 1, 10117 Berlin, Germany
| | - Dimitrios Laurin Wagner
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Charitéplatz 1, 10117 Berlin, Germany.,Berlin Center for Advanced Therapies (BeCAT) at Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Institute of Medical Immunology, Augustenburger Platz 1, 13353 Berlin, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Institute of Transfusion Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Ghazaleh Zarrinrad
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Charitéplatz 1, 10117 Berlin, Germany.,Einstein Center for Regenerative Therapies at Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.,Berlin Center for Advanced Therapies (BeCAT) at Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Sandra Münch
- Berlin Center for Advanced Therapies (BeCAT) at Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Samira Picht
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Charitéplatz 1, 10117 Berlin, Germany
| | - Sarah Schulenberg
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Charitéplatz 1, 10117 Berlin, Germany.,Einstein Center for Regenerative Therapies at Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Hanieh Moradian
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Charitéplatz 1, 10117 Berlin, Germany.,Institute of Active Polymers, Helmholtz-Zentrum Hereon, Kantstr. 55, 14513 Teltow, Germany.,Institute of Biochemistry and Biology, University of Potsdam, Karl-Liebknecht-Str. 24-25, 14476 Potsdam, Germany
| | - Mir-Farzin Mashreghi
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Charitéplatz 1, 10117 Berlin, Germany.,Deutsches Rheuma-Forschungszentrum Berlin, a Leibniz Institute, Charitéplatz 1, 10117 Berlin, Germany
| | - Oliver Klein
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Charitéplatz 1, 10117 Berlin, Germany
| | - Manfred Gossen
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Charitéplatz 1, 10117 Berlin, Germany.,Institute of Active Polymers, Helmholtz-Zentrum Hereon, Kantstr. 55, 14513 Teltow, Germany
| | - Toralf Roch
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Charitéplatz 1, 10117 Berlin, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Institute of Medical Immunology, Augustenburger Platz 1, 13353 Berlin, Germany.,Center for Translational Medicine, Immunology, and Transplantation, Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Hölkeskampring 40, 44625 Herne, Germany
| | - Nina Babel
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Charitéplatz 1, 10117 Berlin, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Institute of Medical Immunology, Augustenburger Platz 1, 13353 Berlin, Germany.,Center for Translational Medicine, Immunology, and Transplantation, Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Hölkeskampring 40, 44625 Herne, Germany
| | - Petra Reinke
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Charitéplatz 1, 10117 Berlin, Germany.,Berlin Center for Advanced Therapies (BeCAT) at Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Hans-Dieter Volk
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Charitéplatz 1, 10117 Berlin, Germany.,Berlin Center for Advanced Therapies (BeCAT) at Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Institute of Medical Immunology, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Leila Amini
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Charitéplatz 1, 10117 Berlin, Germany.,Berlin Center for Advanced Therapies (BeCAT) at Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Michael Schmueck-Henneresse
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Charitéplatz 1, 10117 Berlin, Germany.,Berlin Center for Advanced Therapies (BeCAT) at Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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13
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Altheaby A, Alloqmani D, AlShammari R, Alsuhaibani A, Hakeem A, Alam S, Alharbi S, Al Zunitan M, Bosaeed M, Alharbi NK. Safety and Efficacy of the COVID-19 Vaccine in Kidney Transplant Recipients. Cureus 2022; 14:e24753. [PMID: 35686249 PMCID: PMC9170370 DOI: 10.7759/cureus.24753] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 12/14/2022] Open
Abstract
Background: Kidney transplant recipients appear to be at high risk for critical coronavirus disease 2019 (COVID-19) illness. They are considered a priority for COVID-19 vaccination. Only a few studies report on the safety and efficacy of the COVID-19 vaccine in these patients. Methods: In this prospective observational study, we measured anti-severe acute respiratory syndrome coronavirus 2 (anti-SARS-CoV-2) spike-specific IgG post first and second COVID-19 mRNA vaccines in 113 kidney transplant recipients and compared them to 62 healthy volunteers. Result: After the first COVID-19 vaccine, SARS-CoV-2-specific antibodies were undetectable in 38.9% of kidney transplant recipients, and after the second, it remained undetectable in 12.4%. SARS-CoV-2-specific antibodies were significantly lower in kidney transplant recipients. The average antibody titer after the first vaccine was 1243.6±4137.5 in kidney transplant recipients compared to 20012.2±44436.4 in the controls after the first dose (P=0.002), and 7965.5±12431.3 versus 82891.3±67418.7, respectively, after the second dose (P <0.001). The immune response to the COVID-19 vaccine seemed to be influenced by mycophenolate dose in kidney transplant recipients and pre-vaccination infection. Conclusion: Kidney transplant recipients are prone to have attenuated antibody responses (anti-spike IgGs) to mRNA COVID-19 vaccines. Patients on mycophenolate mofetil (2 gm daily) had significantly lower SARS-CoV-2 spike-specific IgG levels as compared to patients on no or reduced dose of mycophenolate. Hence, kidney transplant recipients need to continue all infection control precautionary measures against COVID-19 infection and should be considered a priority for a third COVID-19 vaccine.
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14
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Charmetant X, Espi M, Barba T, Ovize A, Morelon E, Mathieu C, Thaunat O. Predictive factors of a viral neutralizing humoral response after a third dose of COVID-19 mRNA vaccine. Am J Transplant 2022; 22:1442-1450. [PMID: 35114060 PMCID: PMC10149236 DOI: 10.1111/ajt.16990] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 01/25/2023]
Abstract
Kidney transplant recipients (KTRs) have reduced ability to mount adequate antibody response after two doses of the COVID-19 mRNA vaccine. French health authorities have allowed a third booster dose (D3) for KTRs, but their response is heterogeneous and tools able to discriminate the responders are lacking. Anti-RBD IgG titers (chemiluminescence immunoassay), spike-specific cellular responses (IFN-γ-releasing assay, IGRA), and in vitro serum neutralization of the virus (the best available correlate of protection), were evaluated 7-14 days after the second dose (D2) of BNT162b2 vaccine in 93 KTRs. Among the 73 KTRs, whose serum did not neutralize SARS-CoV-2 in vitro after D2, 14 (19%) acquired this capacity after D3, and were considered as "responders." Exploratory univariate analysis identified short time from transplantation and high maintenance immunosuppression as detrimental factors for the response to D3. In addition, any of the presence of anti-RBD IgGs and/or positive IGRA after D2 was predictive of response to D3. By contrast, none of the KTRs with both a negative serology and IGRA responded to D3. In summary, routinely available bioassays performed after D2 allow identifying KTRs that will respond to a booster D3. These results pave the way for the personalization of vaccination strategy in KTRs.
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Affiliation(s)
- Xavier Charmetant
- CIRI, INSERM U1111, Université Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Univ. Lyon, Lyon, France
| | - Maxime Espi
- CIRI, INSERM U1111, Université Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Univ. Lyon, Lyon, France
| | - Thomas Barba
- CIRI, INSERM U1111, Université Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Univ. Lyon, Lyon, France
| | - Anne Ovize
- Eurofins Biomnis Laboratory, Lyon, France
| | - Emmanuel Morelon
- CIRI, INSERM U1111, Université Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Univ. Lyon, Lyon, France
- Department of Transplantation, Nephrology and Clinical Immunology, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
- Claude Bernard University (Lyon 1), Villeurbanne, France
| | - Cyrille Mathieu
- CIRI, INSERM U1111, Université Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Univ. Lyon, Lyon, France
| | - Olivier Thaunat
- CIRI, INSERM U1111, Université Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Univ. Lyon, Lyon, France
- Department of Transplantation, Nephrology and Clinical Immunology, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
- Claude Bernard University (Lyon 1), Villeurbanne, France
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15
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Bell S, Campbell J, Lambourg E, Watters C, O’Neil M, Almond A, Buck K, Carr EJ, Clark L, Cousland Z, Findlay M, Joss N, Metcalfe W, Petrie M, Spalding E, Traynor JP, Sanu V, Thomson P, Methven S, Mark PB. The Impact of Vaccination on Incidence and Outcomes of SARS-CoV-2 Infection in Patients with Kidney Failure in Scotland. J Am Soc Nephrol 2022; 33:677-686. [PMID: 35110363 PMCID: PMC8970454 DOI: 10.1681/asn.2022010046] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 01/15/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Patients with kidney failure requiring KRT are at high risk of complications and death following SARS-CoV-2 infection, with variable antibody responses to vaccination reported. We investigated the effects of COVID-19 vaccination on the incidence of infection, hospitalization, and death from COVID-19 infection. METHODS The study design was an observational data linkage cohort study. Multiple health care datasets were linked to ascertain all SARS-CoV-2 testing, vaccination, hospitalization, and mortality data for all patients treated with KRT in Scotland from the start of the pandemic over a period of 20 months. Descriptive statistics, survival analyses, and vaccine effectiveness were calculated. RESULTS As of September 19, 2021, 93% (n=5281) of the established KRT population in Scotland had received two doses of an approved SARS-CoV-2 vaccine. Over the study period, there were 814 cases of SARS-CoV-2 infection (15.1% of the KRT population). Vaccine effectiveness rates against infection and hospitalization were 33% (95% CI, 0 to 52) and 38% (95% CI, 0 to 57), respectively. Within 28 days of a SARS-CoV-2-positive PCR test, 9.2% of fully vaccinated individuals died (7% patients on dialysis and 10% kidney transplant recipients). This compares to <0.1% of the vaccinated general Scottish population admitted to the hospital or dying due to COVID-19 during that period. CONCLUSIONS These data demonstrate that a primary vaccine course of two doses has limited effect on COVID-19 infection and its complications in patients with KRT. Adjunctive strategies to reduce risk of both COVID-19 infection and its complications in this population are urgently required.
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Affiliation(s)
- Samira Bell
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, Scotland
- The Scottish Renal Registry, Scottish Health Audits, Public Health Scotland, Glasgow, Scotland
- Renal Unit, Ninewells Hospital, Dundee, Scotland
| | - Jacqueline Campbell
- The Scottish Renal Registry, Scottish Health Audits, Public Health Scotland, Glasgow, Scotland
| | - Emilie Lambourg
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, Scotland
| | - Chrissie Watters
- The Scottish Renal Registry, Scottish Health Audits, Public Health Scotland, Glasgow, Scotland
| | - Martin O’Neil
- The Scottish Renal Registry, Scottish Health Audits, Public Health Scotland, Glasgow, Scotland
| | - Alison Almond
- Renal Unit, Mountainhall Treatment Centre, Dumfries, Scotland
| | | | - Edward J. Carr
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, Scotland
- Cell Biology of Infection Laboratory, Francis Crick Institute, London, United Kingdom
| | - Laura Clark
- Department of Renal Medicine, Foresterhill Health Campus, Aberdeen Royal Infirmary, Aberdeen, Scotland
| | - Zoe Cousland
- Renal Unit, Monklands Hospital, Airdrie, Scotland
| | - Mark Findlay
- Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Nicola Joss
- Renal Unit, Raigmore Hospital, Inverness, Scotland
| | - Wendy Metcalfe
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh Bioquarter, Edinburgh, Scotland
| | - Michaela Petrie
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh Bioquarter, Edinburgh, Scotland
| | - Elaine Spalding
- Renal Unit, University Hospital Crosshouse, Crosshouse, Scotland
| | - Jamie P. Traynor
- Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Vinod Sanu
- Renal Unit, Ninewells Hospital, Dundee, Scotland
| | - Peter Thomson
- Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Shona Methven
- Department of Renal Medicine, Foresterhill Health Campus, Aberdeen Royal Infirmary, Aberdeen, Scotland
| | - Patrick B. Mark
- Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, Scotland
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
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16
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Charmetant X, Espi M, Benotmane I, Barateau V, Heibel F, Buron F, Gautier-Vargas G, Delafosse M, Perrin P, Koenig A, Cognard N, Levi C, Gallais F, Manière L, Rossolillo P, Soulier E, Pierre F, Ovize A, Morelon E, Defrance T, Fafi-Kremer S, Caillard S, Thaunat O. Infection or a third dose of mRNA vaccine elicits neutralizing antibody responses against SARS-CoV-2 in kidney transplant recipients. Sci Transl Med 2022; 14:eabl6141. [PMID: 35103481 PMCID: PMC8939774 DOI: 10.1126/scitranslmed.abl6141] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 01/25/2022] [Indexed: 12/12/2022]
Abstract
Transplant recipients, who receive therapeutic immunosuppression to prevent graft rejection, are characterized by high coronavirus disease 2019 (COVID-19)-related mortality and defective response to vaccines. We observed that previous infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but not the standard two-dose regimen of vaccination, provided protection against symptomatic COVID-19 in kidney transplant recipients. We therefore compared the cellular and humoral immune responses of these two groups of patients. Neutralizing anti-receptor-binding domain (RBD) immunoglobulin G (IgG) antibodies were identified as the primary correlate of protection for transplant recipients. Analysis of virus-specific B and T cell responses suggested that the generation of neutralizing anti-RBD IgG may have depended on cognate T-B cell interactions that took place in germinal center, potentially acting as a limiting checkpoint. High-dose mycophenolate mofetil, an immunosuppressive drug, was associated with fewer antigen-specific B and T follicular helper (TFH) cells after vaccination; this was not observed in patients recently infected with SARS-CoV-2. Last, we observed that, in two independent prospective cohorts, administration of a third dose of SARS-CoV-2 mRNA vaccine restored neutralizing titers of anti-RBD IgG in about 40% of individuals who had not previously responded to two doses of vaccine. Together, these findings suggest that a third dose of SARS-CoV-2 mRNA vaccine improves the RBD-specific responses of transplant patients treated with immunosuppressive drugs.
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Affiliation(s)
- Xavier Charmetant
- CIRI, INSERM U1111, Université Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Univ. Lyon, 21 avenue Tony Garnier, 69007 Lyon, France
| | - Maxime Espi
- CIRI, INSERM U1111, Université Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Univ. Lyon, 21 avenue Tony Garnier, 69007 Lyon, France
| | - Ilies Benotmane
- Department of Nephrology and Transplantation, Strasbourg University Hospital, 67000 Strasbourg, France
- Department of Virology, Strasbourg University Hospital, 67000 Strasbourg, France
- Inserm UMR S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, 67000 Strasbourg, France
| | - Véronique Barateau
- CIRI, INSERM U1111, Université Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Univ. Lyon, 21 avenue Tony Garnier, 69007 Lyon, France
| | - Francoise Heibel
- Department of Nephrology and Transplantation, Strasbourg University Hospital, 67000 Strasbourg, France
| | - Fanny Buron
- Hospices Civils de Lyon, Edouard Herriot Hospital, Department of Transplantation, Nephrology and Clinical Immunology, 5, place d’Arsonval, 69003 Lyon, France
| | - Gabriela Gautier-Vargas
- Department of Nephrology and Transplantation, Strasbourg University Hospital, 67000 Strasbourg, France
| | - Marion Delafosse
- Hospices Civils de Lyon, Edouard Herriot Hospital, Department of Transplantation, Nephrology and Clinical Immunology, 5, place d’Arsonval, 69003 Lyon, France
| | - Peggy Perrin
- Department of Nephrology and Transplantation, Strasbourg University Hospital, 67000 Strasbourg, France
| | - Alice Koenig
- CIRI, INSERM U1111, Université Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Univ. Lyon, 21 avenue Tony Garnier, 69007 Lyon, France
- Hospices Civils de Lyon, Edouard Herriot Hospital, Department of Transplantation, Nephrology and Clinical Immunology, 5, place d’Arsonval, 69003 Lyon, France
- Claude Bernard University (Lyon 1), 43 boulevard du 11 Novembre 1918, 69622 Villeurbanne France
| | - Noëlle Cognard
- Department of Nephrology and Transplantation, Strasbourg University Hospital, 67000 Strasbourg, France
| | - Charlène Levi
- Hospices Civils de Lyon, Edouard Herriot Hospital, Department of Transplantation, Nephrology and Clinical Immunology, 5, place d’Arsonval, 69003 Lyon, France
| | - Floriane Gallais
- Department of Virology, Strasbourg University Hospital, 67000 Strasbourg, France
- Inserm UMR S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, 67000 Strasbourg, France
| | - Louis Manière
- Hospices Civils de Lyon, Edouard Herriot Hospital, Department of Transplantation, Nephrology and Clinical Immunology, 5, place d’Arsonval, 69003 Lyon, France
| | - Paola Rossolillo
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Centre National de la Recherche Scientifique (CNRS), UMR 7104, Institut National de la Santé et de la Recherche Médicale (INSERM), U1258, Université de Strasbourg, 67400 Illkirch, France
| | - Eric Soulier
- Inserm UMR S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, 67000 Strasbourg, France
| | - Florian Pierre
- Inserm UMR S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, 67000 Strasbourg, France
| | - Anne Ovize
- Eurofins Biomnis Laboratory, 69007 Lyon, France
| | - Emmanuel Morelon
- CIRI, INSERM U1111, Université Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Univ. Lyon, 21 avenue Tony Garnier, 69007 Lyon, France
- Hospices Civils de Lyon, Edouard Herriot Hospital, Department of Transplantation, Nephrology and Clinical Immunology, 5, place d’Arsonval, 69003 Lyon, France
- Claude Bernard University (Lyon 1), 43 boulevard du 11 Novembre 1918, 69622 Villeurbanne France
| | - Thierry Defrance
- CIRI, INSERM U1111, Université Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Univ. Lyon, 21 avenue Tony Garnier, 69007 Lyon, France
| | - Samira Fafi-Kremer
- Department of Virology, Strasbourg University Hospital, 67000 Strasbourg, France
- Inserm UMR S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, 67000 Strasbourg, France
| | - Sophie Caillard
- Department of Nephrology and Transplantation, Strasbourg University Hospital, 67000 Strasbourg, France
- Department of Virology, Strasbourg University Hospital, 67000 Strasbourg, France
- Inserm UMR S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, 67000 Strasbourg, France
| | - Olivier Thaunat
- CIRI, INSERM U1111, Université Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Univ. Lyon, 21 avenue Tony Garnier, 69007 Lyon, France
- Hospices Civils de Lyon, Edouard Herriot Hospital, Department of Transplantation, Nephrology and Clinical Immunology, 5, place d’Arsonval, 69003 Lyon, France
- Claude Bernard University (Lyon 1), 43 boulevard du 11 Novembre 1918, 69622 Villeurbanne France
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Callaghan CJ, Mumford L, Curtis RMK, Williams SV, Whitaker H, Andrews N, Lopez Bernal J, Ushiro-Lumb I, Pettigrew GJ, Thorburn D, Forsythe JLR, Ravanan R. Real-world Effectiveness of the Pfizer-BioNTech BNT162b2 and Oxford-AstraZeneca ChAdOx1-S Vaccines Against SARS-CoV-2 in Solid Organ and Islet Transplant Recipients. Transplantation 2022; 106:436-446. [PMID: 34982758 PMCID: PMC8862680 DOI: 10.1097/tp.0000000000004059] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 12/19/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The clinical effectiveness of vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in immunosuppressed solid organ and islet transplant (SOT) recipients is unclear. METHODS We linked 4 national registries to retrospectively identify laboratory-confirmed SARS-CoV-2 infections and deaths within 28 d in England between September 1, 2020, and August 31, 2021, comparing unvaccinated adult SOT recipients and those who had received 2 doses of ChAdOx1-S or BNT162b2 vaccine. Infection incidence rate ratios were adjusted for recipient demographics and calendar month using a negative binomial regression model, with 95% confidence intervals. Case fatality rate ratios were adjusted using a Cox proportional hazards model to generate hazard ratio (95% confidence interval). RESULTS On August 31, 2021, it was found that 3080 (7.1%) were unvaccinated, 1141 (2.6%) had 1 vaccine dose, and 39 260 (90.3%) had 2 vaccine doses. There were 4147 SARS-CoV-2 infections and 407 deaths (unadjusted case fatality rate 9.8%). The risk-adjusted infection incidence rate ratio was 1.29 (1.03-1.61), implying that vaccination was not associated with reduction in risk of testing positive for SARS-CoV-2 RNA. Overall, the hazard ratio for death within 28 d of SARS-CoV-2 infection was 0.80 (0.63-1.00), a 20% reduction in risk of death in vaccinated patients (P = 0.05). Two doses of ChAdOx1-S were associated with a significantly reduced risk of death (hazard ratio, 0.69; 0.52-0.92), whereas vaccination with BNT162b2 was not (0.97; 0.71-1.31). CONCLUSIONS Vaccination of SOT recipients confers some protection against SARS-CoV-2-related mortality, but this protection is inferior to that achieved in the general population. SOT recipients require additional protective measures, including further vaccine doses, antiviral drugs, and nonpharmaceutical interventions.
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Affiliation(s)
- Chris J. Callaghan
- National Health Service Blood and Transplant, Stoke Gifford, Bristol, United Kingdom
| | - Lisa Mumford
- National Health Service Blood and Transplant, Stoke Gifford, Bristol, United Kingdom
| | - Rebecca M. K. Curtis
- National Health Service Blood and Transplant, Stoke Gifford, Bristol, United Kingdom
| | | | | | - Nick Andrews
- UK Health Security Agency, London, United Kingdom
| | | | - Ines Ushiro-Lumb
- National Health Service Blood and Transplant, Stoke Gifford, Bristol, United Kingdom
| | - Gavin J. Pettigrew
- National Health Service Blood and Transplant, Stoke Gifford, Bristol, United Kingdom
| | - Douglas Thorburn
- National Health Service Blood and Transplant, Stoke Gifford, Bristol, United Kingdom
| | - John L. R. Forsythe
- National Health Service Blood and Transplant, Stoke Gifford, Bristol, United Kingdom
| | - Rommel Ravanan
- National Health Service Blood and Transplant, Stoke Gifford, Bristol, United Kingdom
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18
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Wieland E. Immunological Biomarkers in Blood to Monitor the Course and Therapeutic Outcomes of COVID-19. Ther Drug Monit 2022; 44:148-165. [PMID: 34840314 DOI: 10.1097/ftd.0000000000000945] [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: 08/01/2021] [Accepted: 10/29/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The COVID-19 pandemic has posed a great challenge to the medical community because little is known about its clinical course, therapeutic options, and laboratory monitoring tools for diagnosis, prognosis, and surveillance. This review focuses on immune biomarkers that can be measured in peripheral blood in a clinical laboratory under routine conditions to monitor the innate immune system response in the acute phase, as well as the adaptive immune response established both after infection and vaccination. METHODS A PubMed search was performed covering January 2020 to June 2021 to extract biomarkers suitable for monitoring the immune response and outcome of COVID-19 and therapeutic interventions, including vaccination. RESULTS To monitor the innate immune response, cytokines such as interleukin-6 or acute phase reactants such as C-reactive protein or procalcitonin can be measured on autoanalyzers complemented by automated white blood cell differential counts. The adaptive immune response can be followed by commercially available enzyme-linked immune spot assays to assess the specific activation of T cells or by monitoring immunoglobulin A (IgA), IgM, and IgG antibodies in serum to follow B-cell activation. As antigens of the SARS-CoV-2 virus, spike and nucleocapsid proteins are particularly suitable and allow differentiation between the immune response after infection or vaccination. CONCLUSIONS Routine immune monitoring of COVID-19 is feasible in clinical laboratories with commercially available instruments and reagents. Strategies such as whether biomarkers reflecting the response of the innate and adaptive immune system can be used to make predictions and assist in individualizing therapeutic interventions or vaccination strategies need to be determined in appropriate clinical trials. Promising preliminary data are already available based on single-center reports and completed or ongoing vaccination trials.
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19
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Peled Y, Ram E, Lavee J, Segev A, Matezki S, Wieder-Finesod A, Halperin R, Mandelboim M, Indenbaum V, Levy I, Sternik L, Raanani E, Afek A, Kreiss Y, Lustig Y, Rahav G. Third dose of the BNT162b2 vaccine in heart transplant recipients: Immunogenicity and clinical experience. J Heart Lung Transplant 2022; 41:148-157. [PMID: 34565682 PMCID: PMC8397500 DOI: 10.1016/j.healun.2021.08.010] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/20/2021] [Accepted: 08/22/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The repeated waves of the COVID-19 pandemic have highlighted the necessity to optimize vaccine responses in immunocompromised populations. We investigated the safety and immunogenicity of a third, booster, dose of the Pfizer BNT162b2 vaccine in heart transplant (HT) patients. METHODS The cohort comprised 96 adult HT patients who received a third homologous dose of the BNT162b2 vaccine 168 days after the second dose. The vaccine-induced antibody responses of both receptor-binding domain (RBD) IgG and neutralizing antibodies were assessed in all patients, with a positive antibody response being defined as the presence of either IgG anti-RBD or neutralizing antibodies. For a subset of patients, T cell response was also studied. RESULTS The third dose was associated with a low rate of adverse events, mostly mild pain at the injection site. No serious adverse events were recorded, and there were no episodes of rejection. At 18 days following the third dose of the vaccine, the positive antibody response increased from 23% to 67%, with a corresponding increase in neutralizing capacity. The third dose elicited SARS-CoV-2 neutralization titers >9-fold and IgG anti-RBD antibodies >3-fold of the range achieved after the two primary doses. Mycophenolate use, lower eGFR and higher C-reactive protein were independently associated with a reduced likelihood of generating an immune response. Importantly, a specific T-cell response following the third dose was evident in the majority of transplant recipients. CONCLUSIONS An homologous third booster dose of the BNT162b2 vaccine gave overall consistent tolerability and a good safety profile, while eliciting humoral and cellular immune responses.
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Affiliation(s)
- Yael Peled
- Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Eilon Ram
- Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Lavee
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Segev
- Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Matezki
- Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Wieder-Finesod
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Disease Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Rebecca Halperin
- Infectious Disease Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Michal Mandelboim
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Israel
| | | | - Itzchak Levy
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Disease Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Leonid Sternik
- Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Raanani
- Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Afek
- Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yitshak Kreiss
- Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaniv Lustig
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Israel
| | - Galia Rahav
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Disease Unit, Sheba Medical Center, Ramat Gan, Israel
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20
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Bestard O, Jouve T, Castells L, Lopez M, Muñoz M, Crespo E, Toapanta N, Esperalba J, Campos‐Varela I, Pont T, Len O, Campins M, Moreso F. Reconciling short-term clinical and immunological outcomes of SARS-CoV-2 vaccination in solid organ transplant recipients. Am J Transplant 2022; 22:673-675. [PMID: 34554648 PMCID: PMC8653131 DOI: 10.1111/ajt.16855] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/07/2021] [Accepted: 09/16/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Oriol Bestard
- Kidney Transplant UnitNephrology DepartmentVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de BarcelonaBarcelonaSpain,Laboratory of Nephrology and TransplantationVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Thomas Jouve
- Laboratory of Nephrology and TransplantationVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Lluís Castells
- Liver UnitVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)Instituto de Salud Carlos IIIMadridSpain
| | - Manuel Lopez
- Lung Transplant UnitVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Marina Muñoz
- Pediatric Transplant DepartmentVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Elena Crespo
- Laboratory of Nephrology and TransplantationVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Nestor Toapanta
- Kidney Transplant UnitNephrology DepartmentVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - Juliana Esperalba
- Microbiology DepartmentVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Isabel Campos‐Varela
- Liver UnitVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)Instituto de Salud Carlos IIIMadridSpain
| | - Teresa Pont
- Transplant Coordination DepartmentVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Oscar Len
- Infectious Disease DepartmentVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Magda Campins
- Deparment of Preventive Medicine and EpidemiologyVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Francesc Moreso
- Kidney Transplant UnitNephrology DepartmentVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de BarcelonaBarcelonaSpain,Laboratory of Nephrology and TransplantationVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
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21
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Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global healthcare crisis. Kidney transplant (KTx) patients and the patients with chronic kidney disease are two of the most vulnerable populations to the risks of coronavirus disease 2019 (COVID-19). A systematic literature search on PubMed and Web of Science was conducted. We analyzed published case reports, case series and articles on COVID-19’s clinical presentation, management, outcomes and vaccination among kidney transplant recipients. A total of 33 studies were included in the study, which included 1676 KTx recipients and 108 waiting list patients infected with COVID-19. These studies reported the clinical presentation, management and immunosuppressive adjustment among the KTx recipients. The remaining studies focused on other aspects, such as vaccination and transplantation, during the COVID-19 pandemic. Mortality due to COVID-19 was observed to be the highest for KTx recipients, followed by patients on hemodialysis, and lowest in the general population. There is no definitive treatment of COVID-19 yet, and managing transplant patients is enigmatic of this: the treatment is based on symptom management. There is an urgent need for guidelines on managing kidney transplant recipients and immunosuppressive adjustments for the course of COVID-19 treatment.
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22
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Russo G, Lai Q, Poli L, Perrone MP, Gaeta A, Rossi M, Mastroianni CM, Garofalo M, Pretagostini R. SARS-COV-2 vaccination with BNT162B2 in renal transplant patients: Risk factors for impaired response and immunological implications. Clin Transplant 2022; 36:e14495. [PMID: 34569101 PMCID: PMC8646240 DOI: 10.1111/ctr.14495] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 12/27/2022]
Abstract
Solid organ transplant patients are at a higher risk for poor CoronaVirus Disease-2019 (COVID-19)-related outcomes and have been included as a priority group in the vaccination strategy worldwide. We assessed the safety and efficacy of a two-dose vaccination cycle with mRNA-based COVID-19 vaccine (BNT162b2) among 82 kidney transplant outpatients followed in our center in Rome, Italy. After a median of 43 post-vaccine days, a SARS-CoV-2 anti-Spike seroprevalence of 52.4% (n = 43/82) was observed. No impact of the vaccination on antibody-mediated rejection or graft function was observed, and no significant safety concerns were reported. Moreover, no de novo HLA-donor-specific antibodies (DSA) were detected during the follow-up period. Only one patient with pre-vaccination HLA-DSA did not experience an increased intensity of the existing HLA-DSA. During the follow-up, only one infection (mild COVID-19) was observed in a patient after receiving the first vaccine dose. According to the multivariable logistic regression analysis, lack of seroconversion after two-dose vaccination independently associated with patient age ≥60 years (OR = 4.50; P = .02) and use of anti-metabolite as an immunosuppressant drug (OR = 5.26; P = .004). Among younger patients not taking anti-metabolites, the seroconversion rate was high (92.9%). Further larger studies are needed to assess the best COVID-19 vaccination strategy in transplanted patients.
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Affiliation(s)
- Gianluca Russo
- Infectious Disease UnitSapienza University of RomeRomeItaly
| | - Quirino Lai
- General Surgery and Organ Transplantation UnitSapienza University of RomeRomeItaly
| | - Luca Poli
- General Surgery and Organ Transplantation UnitSapienza University of RomeRomeItaly
| | - Maria Paola Perrone
- Immunohematology and Transfusion Medicine UnitSapienza University of RomeRomeItaly
| | - Aurelia Gaeta
- Department of Molecular MedicineSapienza University of RomeRomeItaly
| | - Massimo Rossi
- General Surgery and Organ Transplantation UnitSapienza University of RomeRomeItaly
| | | | - Manuela Garofalo
- General Surgery and Organ Transplantation UnitSapienza University of RomeRomeItaly
| | - Renzo Pretagostini
- General Surgery and Organ Transplantation UnitSapienza University of RomeRomeItaly
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23
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Chauhan M, Nzeako I, Li F, Thuluvath PJ. Antibody response after a booster dose of SARS-CoV-2 vaccine in liver transplant recipients and those with chronic liver diseases. Ann Hepatol 2022; 27:100702. [PMID: 35338012 PMCID: PMC8942457 DOI: 10.1016/j.aohep.2022.100702] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/19/2022] [Accepted: 02/20/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Lower antibody (Ab) responses after SARS-CoV-2 vaccination have been reported in liver transplant (LT) recipients and those with chronic liver diseases (CLD). The role of a booster dose in those with poor responses to initial vaccination is not well defined. METHODS In this prospective study, we determined antibody (Ab) response to spike protein after a booster dose in LT recipients and those with chronic liver diseases (CLD) with and without cirrhosis after they had a poor response to an initial standard regimen. RESULTS Of the 80 patients enrolled, 45 had LT, and 35 had CLD (18 with cirrhosis). A booster dose was given at a median of 138.5 days after the completion of the standard regimen. After the booster dose, 58 (73%, 31 LT, 27 CLD) had good response (≥250 U/mL), and 22 (28%, 14 LT, and 8 CLD) had poor response (7 undetectable and 15 with low Ab levels). No patient had any serious adverse events. The antibody responses were lower in those who had undetectable Ab (80 U/mL) than those who had low levels of Ab (0.80-249 U/mL) after the standard vaccination regimen (42% vs. 87%, p=0.0001). The antibody responses after homologous and heterologous booster doses were similar. CONCLUSIONS We have shown that a booster dose will enhance Ab responses in LT recipients and those with CLD who had poor responses after an initial vaccine regimen.
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Affiliation(s)
- Mahak Chauhan
- Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore, MD, USA
| | - Ihechiluru Nzeako
- Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore, MD, USA
| | - Feng Li
- Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore, MD, USA
| | - Paul J. Thuluvath
- Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore, MD, USA.,Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.,Corresponding author
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Predictive Factors for Humoral Response After 2-dose SARS-CoV-2 Vaccine in Solid Organ Transplant Patients. Transplant Direct 2021; 8:e1248. [PMID: 34966837 PMCID: PMC8710345 DOI: 10.1097/txd.0000000000001248] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/24/2022] Open
Abstract
Background A weak immunogenicity has been reported in solid organ transplant (SOT) recipients after 2 doses of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. The aim of this retrospective study was to identify the predictive factors for humoral response in SOT patients. Methods Three hundred and ninety-three SOT patients from our center with at least 4 wk of follow-up after 2 doses of mRNA-based vaccine were included in this study. Anti-SARS-Cov-2 spike protein antibodies were assessed before and after vaccination. Results Anti-SARS-CoV-2 antibodies were detected in 34% of the patients: 33.7% of kidney transplant patients, 47.7% of liver transplant patients, and 14.3% of thoracic transplant patients (P = 0.005). Independent predictive factors for humoral response after vaccination were male gender, a longer period between transplantation and vaccination, liver transplant recipients, a higher lymphocyte count at baseline, a higher estimated glomerular filtration rate and receiving the tacrolimus + everolimus ± steroids combination. Conversely, the nondevelopment of anti-SARS-CoV-2 antibodies after vaccination was associated with younger patients, thoracic organ recipients, induction therapy recipients, and tacrolimus + mycophenolic acid ± steroids recipients. Conclusions The immunosuppressive regimen is a modifiable predictive factor for humoral response to SARS-CoV-2 vaccine.
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25
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Yetmar ZA, Bhaimia E, Bierle DM, Ganesh R, Razonable RR. Breakthrough COVID-19 after SARS-CoV-2 vaccination in solid organ transplant recipients: An analysis of symptomatic cases and monoclonal antibody therapy. Transpl Infect Dis 2021; 24:e13779. [PMID: 34932874 DOI: 10.1111/tid.13779] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/06/2021] [Accepted: 12/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Solid organ transplant (SOT) recipients are at increased risk for complications from SARS-CoV-2 infection. Little is known regarding clinical course and outcomes of breakthrough COVID-19 in the fully vaccinated SOT population. We sought to describe our cohort of SOT recipients who developed symptomatic breakthrough COVID-19 after full vaccination. METHODS We conducted a retrospective review of SOT recipients diagnosed with COVID-19 at least 14 days after completing SARS-CoV-2 vaccination. Patients were analyzed according to those presenting with mild-to-moderate and severe COVID-19, respectively. We described presenting characteristics, COVID-19 therapy, and analyzed outcomes including emergency department (ED) visits, hospitalization, and intensive care unit (ICU) admission. RESULTS Thirty-five patients met inclusion criteria. These had a mean age of 60.8 years and kidney transplant was the most common SOT type. Five patients presented with severe COVID-19 at diagnosis, all requiring hospitalization without ICU admission. From the 30 patients who presented with mild-to-moderate infection, 28 received casirivimab-imdevimab. Four of these 28 (14.3%) had an ED visit, with one requiring hospital admission (3.4%). No patients required ICU admission. CONCLUSION Breakthrough COVID-19 may occur in SOT recipients after full vaccination, though they appear to have acceptable outcomes. Anti-spike monoclonal antibody therapy for eligible SOT patients may have mitigated clinical progression and improved the outcomes. Further study with large cohorts is warranted. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Zachary A Yetmar
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric Bhaimia
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Dennis M Bierle
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ravindra Ganesh
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Raymund R Razonable
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA.,William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA
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26
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Yılmaz EA, Özdemir Ö. Solid organ transplantations and COVID-19 disease. World J Transplant 2021; 11:503-511. [PMID: 35070786 PMCID: PMC8713305 DOI: 10.5500/wjt.v11.i12.503] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/04/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
Tens of thousands of people worldwide became infected with severe acute respiratory syndrome coronavirus-2. Death rate in the general population is about 1%-6%, but this rate rises up to 15% in those with comorbidities. Recent publications showed that the clinical progression of this disease in organ recipients is more destructive, with a fatality rate of up to 14%-25%. We aimed to review the effect of the pandemic on various transplantation patients. Coronavirus disease 2019 (COVID-19) has not only interrupted the lives of waiting list patients’; it has also impacted transplantation strategies, transplant surgeries and broken donation chains. COVID-19 was directly and indirectly accountable for a 73% surplus in mortality of this population as compared to wait listed patients in earlier years. The impact of chronic immunosuppression on outcomes of COVID-19 remains unclear but understanding the immunological mechanisms related to the virus is critically important for the lifetime of transplantation and immune suppressed patients. It is hard to endorse changing anti-rejection therapy, as the existing data evaluation is not adequate to advise substituting tacrolimus with cyclosporine during severe COVID-19 disease.
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Affiliation(s)
- Emine Aylin Yılmaz
- Division of Pediatric Allergy and Immunology, Sakarya University Medical Faculty, Adapazarı 54100, Sakarya, Turkey
| | - Öner Özdemir
- Division of Pediatric Allergy and Immunology, Sakarya University Medical Faculty, Adapazarı 54100, Sakarya, Turkey
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27
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Stainer A, Amati F, Suigo G, Simonetta E, Gramegna A, Voza A, Aliberti S. COVID-19 in Immunocompromised Patients: A Systematic Review. Semin Respir Crit Care Med 2021; 42:839-858. [PMID: 34918325 DOI: 10.1055/s-0041-1740110] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was first identified as a novel coronavirus in Wuhan, Hubei province, central China, in December 2019, and is responsible for the 2019-to-present pandemic. According to the most recent data released by the World Health Organization, more than 200 million people have been infected by SARS-CoV-2 so far, and more than 4 million people died worldwide. Although our knowledge on SARS-CoV-2 and COVID-19 is constantly growing, data on COVID-19 in immunocompromised patients are still limited. The aim of the present systematic review is to describe clinical picture, disease severity, proposed treatment regimen, and response to vaccination in patients with different types and severity of immunosuppression.
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Affiliation(s)
- Anna Stainer
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Respiratory Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Francesco Amati
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Respiratory Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giulia Suigo
- Respiratory Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Edoardo Simonetta
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Respiratory Department, Milan, Italy
| | - Andrea Gramegna
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Respiratory Department, Milan, Italy
| | - Antonio Voza
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Emergency Medicine Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Respiratory Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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28
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SARS-CoV-2 infection in fully vaccinated patients with multiple myeloma. Blood Cancer J 2021; 11:201. [PMID: 34907155 PMCID: PMC8669415 DOI: 10.1038/s41408-021-00597-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/23/2021] [Accepted: 11/29/2021] [Indexed: 11/16/2022] Open
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29
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Waldman M, Soler MJ, García-Carro C, Lightstone L, Turner-Stokes T, Griffith M, Torras J, Martinez Valenzuela L, Bestard O, Geddes C, Flossmann O, Budge KL, Cantarelli C, Fiaccadori E, Delsante M, Morales E, Gutierrez E, Niño-Cruz JA, Martinez-Rueda AJ, Comai G, Bini C, La Manna G, Slon MF, Manrique J, Avello A, Fernandez-Prado R, Ortiz A, Marinaki S, Martin Varas CR, Rabasco Ruiz C, Sierra-Carpio M, García-Agudo R, Fernández Juárez G, Hamilton AJ, Bruchfeld A, Chrysochou C, Howard L, Sinha S, Leach T, Agraz Pamplona I, Maggiore U, Cravedi P. COVID-19 in Patients with Glomerular Disease: Follow-Up Results from the IRoc-GN International Registry. KIDNEY360 2021; 3:293-306. [PMID: 35373130 PMCID: PMC8967646 DOI: 10.34067/kid.0006612021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/03/2021] [Indexed: 02/08/2023]
Abstract
Background The acute and long-term effects of severe acute respiratory syndrome coronavirus 2 infection in individuals with GN are still unclear. To address this relevant issue, we created the International Registry of COVID-19 infection in GN. Methods We collected serial information on kidney-related and -unrelated outcomes from 125 GN patients (63 hospitalized and 62 outpatients) and 83 non-GN hospitalized patients with coronavirus disease 2019 (COVID-19) and a median follow-up period of 6.4 (interquartile range 2.3-9.6) months after diagnosis. We used logistic regression for the analyses of clinical outcomes and linear mixed models for the longitudinal analyses of eGFR. All multiple regression models were adjusted for age, sex, ethnicity, and renin-angiotensin-aldosterone system inhibitor use. Results After adjustment for pre-COVID-19 eGFR and other confounders, mortality and AKI did not differ between GN patients and controls (adjusted odds ratio for AKI=1.28; 95% confidence interval [CI], 0.46 to 3.60; P=0.64). The main predictor of AKI was pre-COVID-19 eGFR (adjusted odds ratio per 1 SD unit decrease in eGFR=3.04; 95% CI, 1.76 to 5.28; P<0.001). GN patients developing AKI were less likely to recover pre-COVID-19 eGFR compared with controls (adjusted 6-month post-COVID-19 eGFR=0.41; 95% CI, 0.25 to 0.56; times pre-COVID-19 eGFR). Shorter duration of GN diagnosis, higher pre-COVID-19 proteinuria, and diagnosis of focal segmental glomerulosclerosis or minimal change disease were associated with a lower post-COVID-19 eGFR. Conclusions Pre-COVID-19 eGFR is the main risk factor for AKI regardless of GN diagnosis. However, GN patients are at higher risk of impaired eGFR recovery after COVID-19-associated AKI. These patients (especially those with high baseline proteinuria or a diagnosis of focal segmental glomerulosclerosis or minimal change disease) should be closely monitored not only during the acute phases of COVID-19 but also after its resolution.
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Affiliation(s)
- Meryl Waldman
- Kidney Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Maria Jose Soler
- Servei Nefrologia, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain,Grup de Recerca de Nefrología, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Clara García-Carro
- Servei Nefrologia, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain,Grup de Recerca de Nefrología, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Liz Lightstone
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Faculty of Medicine, Imperial College London, United Kingdom,Imperial College Healthcare NHS Trust Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - Tabitha Turner-Stokes
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Faculty of Medicine, Imperial College London, United Kingdom,Imperial College Healthcare NHS Trust Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - Megan Griffith
- Imperial College Healthcare NHS Trust Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - Joan Torras
- Nephrology Department, Bellvitge University Hospital, Clinical Science Department, Barcelona University, IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Laura Martinez Valenzuela
- Nephrology Department, Bellvitge University Hospital, Clinical Science Department, Barcelona University, IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Oriol Bestard
- Servei Nefrologia, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain,Grup de Recerca de Nefrología, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Colin Geddes
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Oliver Flossmann
- Department of Nephrology, Royal Berkshire Hospital, Reading, United Kingdom
| | - Kelly L. Budge
- Department of Medicine, Renal Division, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Chiara Cantarelli
- Dipartimento di Medicina e Chirurgia, Università di Parma, UO Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Enrico Fiaccadori
- Dipartimento di Medicina e Chirurgia, Università di Parma, UO Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Marco Delsante
- Dipartimento di Medicina e Chirurgia, Università di Parma, UO Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Enrique Morales
- Departamento de Nefrología, Hospital Universitario 12 de Octubre/Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Eduardo Gutierrez
- Departamento de Nefrología, Hospital Universitario 12 de Octubre/Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Jose A. Niño-Cruz
- Departamento de Nefrología y Metabolismo Mineral Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Armando J. Martinez-Rueda
- Departamento de Nefrología y Metabolismo Mineral Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Giorgia Comai
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria de Bologna, Alma Mater Studiorum University of Bologna, Italy, Bologna, Italy
| | - Claudia Bini
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria de Bologna, Alma Mater Studiorum University of Bologna, Italy, Bologna, Italy
| | - Gaetano La Manna
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria de Bologna, Alma Mater Studiorum University of Bologna, Italy, Bologna, Italy
| | | | | | - Alejandro Avello
- Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain,Nephrology and Hypertension, Fundación Instituto de Investigación Sanitaria-Fundación Jiménez Díaz-Universidad Autónoma Madrid, Madrid, Spain
| | - Raul Fernandez-Prado
- Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain,Nephrology and Hypertension, Fundación Instituto de Investigación Sanitaria-Fundación Jiménez Díaz-Universidad Autónoma Madrid, Madrid, Spain
| | - Alberto Ortiz
- Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain,Nephrology and Hypertension, Fundación Instituto de Investigación Sanitaria-Fundación Jiménez Díaz-Universidad Autónoma Madrid, Madrid, Spain
| | - Smaragdi Marinaki
- Clinic of Nephrology and Renal Transplantation, NKUA, Medical School, Laiko General Hospital, Athens, Greece
| | | | | | | | - Rebeca García-Agudo
- Nephrology Department La Mancha-Centro Hospital, Alcázar de San Juan, Ciudad Real, Spain
| | | | | | - Annette Bruchfeld
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden,Department of Renal Medicine, Karolinska University Hospital and CLINTEC Karolinska Institutet, Stockholm, Sweden
| | - Constantina Chrysochou
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom,Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Lilian Howard
- Kidney Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Smeeta Sinha
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom,Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Tim Leach
- Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom
| | - Irene Agraz Pamplona
- Servei Nefrologia, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain,Grup de Recerca de Nefrología, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Umberto Maggiore
- Dipartimento di Medicina e Chirurgia, Università di Parma, UO Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Paolo Cravedi
- Department of Medicine, Renal Division, Icahn School of Medicine at Mount Sinai, New York, New York
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30
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Montagud-Marrahi E, Cucchiari D, Cuadrado-Payán E, Cofan F, Torregrosa JV, Ventura-Aguiar P, Revuelta I, Bodro M, Piñeiro GJ, Esforzado N, Campistol JM, Oppenheimer F, Marcos MÁ, Bayés B, Moreno A, Diekmann F. SARS-CoV-2 Infection After Full Vaccination in Kidney Transplant Recipients. Transplantation 2021; 105:e278-e279. [PMID: 34406187 PMCID: PMC8612844 DOI: 10.1097/tp.0000000000003927] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Enrique Montagud-Marrahi
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - David Cucchiari
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Elena Cuadrado-Payán
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Frederic Cofan
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Josep-Vicens Torregrosa
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Pedro Ventura-Aguiar
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Red de Investigación Renal (REDINREN), Madrid, Spain
| | - Ignacio Revuelta
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Red de Investigación Renal (REDINREN), Madrid, Spain
| | - Marta Bodro
- Department of Infectious Diseases, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Gaston J. Piñeiro
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Red de Investigación Renal (REDINREN), Madrid, Spain
| | - Nuria Esforzado
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Josep M. Campistol
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Red de Investigación Renal (REDINREN), Madrid, Spain
| | - Federico Oppenheimer
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M. Ángeles Marcos
- Virology Division, Microbiology Department, Biomedical Diagnosis Center, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Beatriu Bayés
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Asunción Moreno
- Department of Infectious Diseases, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Fritz Diekmann
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Red de Investigación Renal (REDINREN), Madrid, Spain
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31
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Moschetta MO, Hadi RA, Franco RF, Wink PL, Barth AL, Gonçalves LFS, Bauer AC, Manfro RC. COVID-19 Reinfection by the Gamma Variant in Kidney Transplant Recipients. Transplantation 2021; 105:e276-e277. [PMID: 34392271 PMCID: PMC8612850 DOI: 10.1097/tp.0000000000003924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 07/31/2021] [Accepted: 08/02/2021] [Indexed: 12/04/2022]
Affiliation(s)
| | - Riad Abdel Hadi
- Division of Nephrology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Division of Transplantation, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Rodrigo Fontanive Franco
- Division of Nephrology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Division of Transplantation, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Priscila Lamb Wink
- Laboratory of Bacterial Resistance (LABRESIS), Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Afonso Luis Barth
- Laboratory of Bacterial Resistance (LABRESIS), Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Luiz Felipe Santos Gonçalves
- Division of Nephrology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Division of Transplantation, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Medical School - Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil
| | - Andrea Carla Bauer
- Division of Nephrology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Division of Transplantation, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Medical School - Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil
| | - Roberto Ceratti Manfro
- Division of Nephrology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Division of Transplantation, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Medical School - Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil
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32
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Chavarot N, Morel A, Leruez-Ville M, Vilain E, Divard G, Burger C, Serris A, Sberro-Soussan R, Martinez F, Amrouche L, Bererhi L, Lanternier F, Legendre C, Zuber J, Anglicheau D, Scemla A. Weak antibody response to three doses of mRNA vaccine in kidney transplant recipients treated with belatacept. Am J Transplant 2021; 21:4043-4051. [PMID: 34431207 PMCID: PMC9906354 DOI: 10.1111/ajt.16814] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 01/25/2023]
Abstract
Poor responses to mRNA COVID-19 vaccine have been reported after 2 vaccine injections in kidney transplant recipients (KTRs) treated with belatacept. We analyzed the humoral response in belatacept-treated KTRs without a history of SARS-CoV-2 infection who received three injections of BNT162b2-mRNA COVID-19 vaccine. We also investigated vaccine immunogenicity in belatacept-treated KTRs with prior COVID-19 and characterized symptomatic COVID-19 infections after the vaccine in belatacept-treated KTRs. Among the 62 belatacept-treated KTRs (36 [58%] males), the median age (63.5 years IQR [51-72]), without COVID-19 history, only four patients (6.4%) developed anti-SARS-CoV-2 IgG with low antibody titers (median 209, IQR [20-409] AU/ml). 71% were treated with mycophenolic acid and 100% with steroids in association with belatacept. In contrast, in all the 5 KTRs with prior COVID-19 history, mRNA vaccine induced a strong antibody response with high antibody titers (median 10 769 AU/ml, IQR [6410-20 069]) after two injections. Seroprevalence after three-vaccine doses in 35 non-belatacept-treated KTRs was 37.1%. Twelve KTRs developed symptomatic COVID-19 after vaccination, including severe forms (50% of mortality). Breakthrough COVID-19 occurred in 5% of fully vaccinated patients. Administration of a third dose of BNT162b2 mRNA COVID-19 vaccine did not improve immunogenicity in KTRs treated with belatacept without prior COVID-19. Other strategies aiming to improve patient protection are needed.
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Affiliation(s)
- Nathalie Chavarot
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Antoine Morel
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marianne Leruez-Ville
- Université de Paris, Paris, France
- Virology Laboratory, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Estelle Vilain
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gillian Divard
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Carole Burger
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Alexandra Serris
- Université de Paris, Paris, France
- Department of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Rebecca Sberro-Soussan
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Frank Martinez
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Lucile Amrouche
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Lynda Bererhi
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fanny Lanternier
- Université de Paris, Paris, France
- Department of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christophe Legendre
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Julien Zuber
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Dany Anglicheau
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Anne Scemla
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
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Alberca RW, Benard G, Alberca GGF, Sato MN. SARS-CoV-2 infection in liver transplant recipients: A complex relationship. World J Gastroenterol 2021; 27:7734-7738. [PMID: 34908810 PMCID: PMC8641049 DOI: 10.3748/wjg.v27.i44.7734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/14/2021] [Accepted: 11/21/2021] [Indexed: 02/06/2023] Open
Abstract
The recent manuscript reviewed investigations involving liver damage in coronavirus disease 2019 (COVID-19) patients, and COVID-19 in patients with previous chronic hepatological diseases, such as patients with liver graft. The literature presents several conflicting results concerning the anti-SARS-CoV-2 response in patients with solid organ transplants, in liver transplant recipients. Therefore, we would like to humbly state a few points for consideration involving liver transplant recipients and COVID-19, such as the time since transplantation, comorbidities, and immunosuppressive regimens.
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Affiliation(s)
- Ricardo Wesley Alberca
- Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Departamento de Dermatologia e Institute de Medicina Tropical, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo 01246-903, Brazil
| | - Gil Benard
- Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Departamento de Dermatologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo 01246-903, Brazil
| | - Gabriela Gama Freire Alberca
- Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Departamento de Dermatologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo 01246-903, Brazil
| | - Maria Notomi Sato
- Laboratorio de Dermatologia e Imunodeficiencias (LIM-56), Departamento de Dermatologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo 01246-903, Brazil
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Discordance Between SARS-CoV-2-specific Cell-mediated and Antibody Responses Elicited by mRNA-1273 Vaccine in Kidney and Liver Transplant Recipients. Transplant Direct 2021; 7:e794. [PMID: 34805496 PMCID: PMC8601286 DOI: 10.1097/txd.0000000000001246] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/07/2021] [Accepted: 09/23/2021] [Indexed: 12/22/2022] Open
Abstract
Supplemental Digital Content is available in the text. Severe acute respiratory syndrome coronavirus 2–specific cell-mediated immunity (SARS-CoV-2-CMI) elicited by mRNA-based vaccines in solid organ transplant (SOT) recipients and its correlation with antibody responses remain poorly characterized.
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35
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Haskin O, Ashkenazi-Hoffnung L, Ziv N, Borovitz Y, Dagan A, Levi S, Koren G, Hamdani G, Levi-Erez D, Landau D, Alfandary H. Serological Response to the BNT162b2 COVID-19 mRNA Vaccine in Adolescent and Young Adult Kidney Transplant Recipients. Transplantation 2021; 105:e226-e233. [PMID: 34381004 PMCID: PMC8549126 DOI: 10.1097/tp.0000000000003922] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/21/2021] [Accepted: 07/28/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Initial reports in adult kidney transplant recipients (KTR) indicate low immunogenicity after 2 doses of the BNT162b2 COVID-19 mRNA vaccine. We describe the immunogenicity of this vaccine compared to the serologic response in naturally infected COVID-19 positive adolescent and young adult KTR. METHODS For this prospective observational study, the study group included 38 KTR who received 2 doses of the tested vaccine, and the control group included 14 KTR who had a previous polymerase chain reaction-confirmed COVID-19 infection. RESULTS The mean age was 18 ± 3 y. Positive serologic responses were observed in 63% and 100% of the study and control groups, respectively (P = 0.01). Antibody titers were almost 30-fold higher in the control than the study group (median [interquartile range (IQR)]: 2782 [1908-11 000] versus 100.3 [4.7-1744] AU/mL, P < 0.001), despite the longer time from the COVID-19 infection to serologic testing compared to time from vaccination (median [IQR]: 157.5 [60-216] versus 37 [20.5-53] d, P = 0.011). Among vaccinated patients, higher proportions of those seronegative than seropositive were previously treated with rituximab (50% versus 8%, P = 0.01). Time from the second vaccine dose to serologic testing was longer in seropositive than seronegative patients (median [IQR]: 24.5 [15-40] versus 46 [27-56] d, P = 0.05). No patient developed symptomatic COVID-19 disease postvaccination. CONCLUSIONS The BNT162b2 COVID-19 mRNA vaccine yielded higher positive antibody response in adolescent and young adult KTR than previously reported for adult KTR. Antibody titers after vaccination were significantly lower than following COVID-19 infection. Longer time may be required to mount appropriate humoral immunity to vaccination in KTR.
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Affiliation(s)
- Orly Haskin
- Institute of Nephrology, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liat Ashkenazi-Hoffnung
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Infectious Disease Unit, Day Hospitalization Department, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
| | - Noa Ziv
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatrics “C”, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
| | - Yael Borovitz
- Institute of Nephrology, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
| | - Amit Dagan
- Institute of Nephrology, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shelly Levi
- Institute of Nephrology, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gili Koren
- Institute of Nephrology, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
| | - Gilad Hamdani
- Institute of Nephrology, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
| | - Daniella Levi-Erez
- Institute of Nephrology, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Landau
- Institute of Nephrology, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadas Alfandary
- Institute of Nephrology, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kute V, Meshram HS, Sharma A, Chaudhury AR, Sudhindran S, Gokhale AK, Hote M, Guleria R, Rana DS, Prakash J, Ramesh V. Update on Coronavirus 2019 Vaccine Guidelines for Transplant Recipients. Transplant Proc 2021; 54:1399-1404. [PMID: 34690000 PMCID: PMC8486636 DOI: 10.1016/j.transproceed.2021.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The coronavirus disease 2019 (COVID-19) vaccine and its utility in solid organ transplantation need to be timely revised and updated. These guidelines have been formalized by the experts—the apex technical committee members of the National Organ and Tissue Transplant Organization and the heads of transplant societies—for the guidance of transplant communities. We recommend that all personnel involved in organ transplantation should be vaccinated as early as possible and continue COVID-19–appropriate behavior despite a full course of vaccination. For specific guidelines of recipients, we suggest completing the full schedule before transplantation whenever the clinical condition permits. We also suggest a single dose, rather than proceeding unvaccinated for transplant, in case a complete course is not feasible. If vaccination is planned before surgery, we recommend a gap of at least 2 weeks between the last dose of vaccine and surgery. For those not vaccinated before transplant, we suggest waiting 4 to 12 weeks after transplant. For the potential living donors, we recommend the complete vaccination schedule before transplant. However, if this is not feasible, we suggest receiving at least a single dose of the vaccine 2 weeks before donation. We suggest that suitable transplant patients and those on the waiting list should accept a third dose of the vaccine when one is offered to them. We recommend that organs from a deceased donor with suspected/proven vaccine-induced thrombotic thrombocytopenia should be avoided and are justified only in cases of emergency situations with informed consent and counseling.
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Affiliation(s)
- Vivek Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr H.L. Trivedi Institute of Transplantation Sciences, Ahmedabad, India
| | - Hari Shankar Meshram
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr H.L. Trivedi Institute of Transplantation Sciences, Ahmedabad, India
| | - Ashish Sharma
- Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Arpita Ray Chaudhury
- Department of Nephrology, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - S Sudhindran
- Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences, Kochi, India
| | | | - Milind Hote
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Director, All India Institute of Medical Sciences, New Delhi, India
| | | | - Jai Prakash
- Department of Nephrology, Banaras Hindu University, Varanasi
| | - Vasanthi Ramesh
- National Organ and Tissue Transplant Organisation, New Delhi, India; Directorate General of Health Services, Ministry of Health and Family Welfare, New Delhi, India; Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
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Fernández-Ruiz M. COVID-19 en receptores de trasplante renal: ¿qué hemos aprendido tras 18 meses de pandemia? ENFERMERÍA NEFROLÓGICA 2021; 24:219-231. [DOI: 10.37551/s2254-28842021020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
La infección por el SARS-CoV-2 (COVID-19) ha supuesto un importante impacto en la actividad trasplantadora en nuestro país. En su condición de paciente inmunodeprimido y con frecuentes comorbilidades, era esperable que la mortalidad y el riesgo de complicaciones asociadas a la COVID-19 en el receptor de trasplante renal (TR) fueran mayores en comparación con la población general, si bien la información al respecto en los primeros meses de la pandemia era muy limitada. Desde marzo de 2020 hemos mejorado rápidamente nuestro conocimiento acerca de la epidemiología, características clínicas y manejo de la COVID-19 post-trasplante. La presente revisión pretende recopilar la información disponible a julio de 2021 en respuesta a una serie de cuestiones relevantes: ¿cómo se manifiesta clínicamente la infección por SARS-CoV-2 en receptores de TR?, ¿cuáles son sus factores pronósticos?, ¿es más grave la COVID-19 en el contexto del TR respecto a los pacientes inmunocompetentes?, ¿de qué opciones de tratamiento antiviral disponemos actualmente para el receptor de TR?, ¿cuál es la experiencia disponible con los tratamientos inmunomoduladores? y, por último, ¿son eficaces las vacunas frente a la COVID-19 basadas en ARN mensajero en esta población?. A pesar de los avances realizados aún son varios los aspectos que debemos mejorar en nuestro abordaje de la infección por SARS-CoV-2 en el ámbito específico del TR.
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Affiliation(s)
- Mario Fernández-Ruiz
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (i+12). Madrid, Departamento de Medicina. Facultad de Medicina. Universidad Complutense. Madrid
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38
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Werbel WA, Boyarsky BJ, Ou MT, Massie AB, Tobian AAR, Garonzik-Wang JM, Segev DL. Safety and Immunogenicity of a Third Dose of SARS-CoV-2 Vaccine in Solid Organ Transplant Recipients: A Case Series. Ann Intern Med 2021; 174:1330-1332. [PMID: 34125572 PMCID: PMC8252023 DOI: 10.7326/l21-0282] [Citation(s) in RCA: 257] [Impact Index Per Article: 85.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- William A Werbel
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brian J Boyarsky
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael T Ou
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Allan B Massie
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aaron A R Tobian
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Dorry L Segev
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Carr EJ, Kronbichler A, Graham-Brown M, Abra G, Argyropoulos C, Harper L, Lerma EV, Suri RS, Topf J, Willicombe M, Hiremath S. Review of Early Immune Response to SARS-CoV-2 Vaccination Among Patients With CKD. Kidney Int Rep 2021; 6:2292-2304. [PMID: 34250319 PMCID: PMC8257418 DOI: 10.1016/j.ekir.2021.06.027] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/07/2021] [Accepted: 06/21/2021] [Indexed: 02/07/2023] Open
Abstract
The effects of the coronavirus disease-2019 (COVID-19) pandemic, particularly among those with chronic kidney disease (CKD), who commonly have defects in humoral and cellular immunity, and the efficacy of vaccinations against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are uncertain. To inform public health and clinical practice, we synthesized published studies and preprints evaluating surrogate measures of immunity after SARS-CoV-2 vaccination in patients with CKD, including those receiving dialysis or with a kidney transplant. We found 35 studies (28 published, 7 preprints), with sample sizes ranging from 23 to 1140 participants and follow-up ranging from 1 week to 1 month after vaccination. Seventeen of these studies enrolled a control group. In the 22 studies of patients receiving dialysis, the development of antibodies was observed in 18% to 53% after 1 dose and in 70% to 96% after 2 doses of mRNA vaccine. In the 14 studies of transplant recipients, 3% to 59% mounted detectable humoral or cellular responses after 2 doses of mRNA vaccine. After vaccination, there were a few reported cases of relapse or de novo glomerulonephritis, and acute transplant rejection, suggesting a need for ongoing surveillance. Studies are needed to better evaluate the effectiveness of SARS-CoV-2 vaccination in these populations. Rigorous surveillance is necessary for detection of long-term adverse effects in patients with autoimmune disease and transplant recipients. For transplant recipients and those with suboptimal immune responses, alternate vaccination platforms and strategies should be considered. As additional data arise, the NephJC COVID-19 page will continue to be updated (http://www.nephjc.com/news/covid-vaccine).
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Affiliation(s)
| | | | | | - Graham Abra
- Satellite Healthcare, San Jose, California, USA
- Division of Nephrology, Department of Medicine, Stanford University, Palo Alto, California, USA
| | - Christos Argyropoulos
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Lorraine Harper
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Edgar V. Lerma
- Section of Nephrology, University of Illinois at Chicago/Advocate Christ Medical Center, Oak Lawn, Illinois, USA
| | - Rita S. Suri
- Research Institute, University Health Center, Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Joel Topf
- Department of Medicine, Oakland University William Beaumont School of Medicine, Detroit, Michigan, USA
| | | | - Swapnil Hiremath
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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40
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Peluso MJ, Munter SE, Lynch KL, Yun C, Torres L, Iyer NS, Donatelli J, Ryan L, Deitchman AN, Deeks SG, Rutishauser RL, Henrich TJ. Discordant Virus-Specific Antibody Levels, Antibody Neutralization Capacity, and T-cell Responses Following 3 Doses of SARS-CoV-2 Vaccination in a Patient With Connective Tissue Disease. Open Forum Infect Dis 2021; 8:ofab393. [PMID: 34395717 PMCID: PMC8344490 DOI: 10.1093/ofid/ofab393] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/21/2021] [Indexed: 11/28/2022] Open
Abstract
We report a patient with connective tissue disease who developed modest severe acute respiratory syndrome coronavirus 2 receptor binding domain–specific antibody levels and a lack of neutralization capacity, despite having received 3 mRNA coronavirus disease 2019 vaccines and holding anti-B-cell therapy for >7 months before vaccination. The patient developed virus-specific T-cell responses.
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Affiliation(s)
- Michael J Peluso
- Division of HIV, Infectious Disease and Global Medicine, University of California San Francisco, San Francisco, California, USA
| | - Sadie E Munter
- Division of Experimental Medicine, University of California San Francisco, San Francisco, California, USA
| | - Kara L Lynch
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Cassandra Yun
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Leonel Torres
- Division of Experimental Medicine, University of California San Francisco, San Francisco, California, USA
| | - Nikita S Iyer
- Division of Experimental Medicine, University of California San Francisco, San Francisco, California, USA
| | - Joanna Donatelli
- Division of Experimental Medicine, University of California San Francisco, San Francisco, California, USA
| | - Lindsay Ryan
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Amelia N Deitchman
- Department of Clinical Pharmacology, University of California San Francisco, San Francisco, California, USA
| | - Steven G Deeks
- Division of HIV, Infectious Disease and Global Medicine, University of California San Francisco, San Francisco, California, USA
| | - Rachel L Rutishauser
- Division of Experimental Medicine, University of California San Francisco, San Francisco, California, USA
| | - Timothy J Henrich
- Division of Experimental Medicine, University of California San Francisco, San Francisco, California, USA
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41
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Breakthrough COVID-19 infections after mRNA vaccination in Solid Organ Transplant Recipients in Miami, Florida. Transplantation 2021; 105:e139-e141. [PMID: 34319928 PMCID: PMC8487698 DOI: 10.1097/tp.0000000000003902] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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42
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Toapanta N, Bestard O, Soler MJ. SARS CoV-2 vaccination in patients receiving kidney replacement therapies: where are we now with the protective immune response? Nephrol Dial Transplant 2021; 36:1950-1954. [PMID: 34289072 PMCID: PMC8344521 DOI: 10.1093/ndt/gfab227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Indexed: 01/29/2023] Open
Affiliation(s)
- Nestor Toapanta
- Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Oriol Bestard
- Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Research, Barcelona, Spain
| | - María José Soler
- Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Research, Barcelona, Spain
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Loconsole D, Stea ED, Sallustio A, Fontò G, Pronzo V, Simone S, Centrone F, Accogli M, Gesualdo L, Chironna M. Severe COVID-19 by SARS-CoV-2 Lineage B.1.1.7 in Vaccinated Solid-Organ Transplant Recipients: New Preventive Strategies Needed to Protect Immunocompromised Patients. Vaccines (Basel) 2021; 9:vaccines9080806. [PMID: 34451931 PMCID: PMC8402384 DOI: 10.3390/vaccines9080806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/15/2021] [Accepted: 07/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Solid-organ transplant (SOT) recipients are at a high risk of severe COVID-19, and are priority for vaccination. Here, we describe three cases of severe COVID-19 caused by SARS-CoV-2 B.1.1.7 lineage in vaccinated SOT recipients. METHODS Three SOT patients were hospitalized in the Policlinico Hospital of Bari (southern Italy) and underwent nasopharyngeal swabs for molecular detection of SARS-CoV-2 genes and spike protein mutations by real-time PCR. One sample was subjected to whole-genome sequencing. RESULTS One patient was a heart transplant recipient and two were kidney transplant recipients. All were hospitalized with severe COVID-19 between March and May 2021. Two patients were fully vaccinated and one had received only one dose of the BNT162b2 mRNA vaccine. All the patients showed a high viral load at diagnosis, and molecular typing revealed the presence of B.1.1.7 lineage SARS-CoV-2. In all three cases, prolonged viral shedding was reported. CONCLUSIONS The three cases pose concern about the role of the B.1.1.7 lineage in severe COVID-19 and about the efficacy of COVID-19 vaccination in immunocompromised patients. Protecting immunocompromised patients from COVID-19 is a challenge. SOT recipients show a suboptimal response to standard vaccination, and thus, an additive booster or a combined vaccination strategy with mRNA, protein/subunit, and vector-based vaccines may be necessary. This population should continue to practice strict COVID-19 precautions post-vaccination, until new strategies for protection are available.
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Affiliation(s)
- Daniela Loconsole
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, 70124 Bari, Italy; (D.L.); (F.C.); (M.A.)
| | - Emma Diletta Stea
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (E.D.S.); (G.F.); (V.P.); (S.S.); (L.G.)
| | - Anna Sallustio
- Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Hygiene Unit, 70124 Bari, Italy;
| | - Giulia Fontò
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (E.D.S.); (G.F.); (V.P.); (S.S.); (L.G.)
| | - Virginia Pronzo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (E.D.S.); (G.F.); (V.P.); (S.S.); (L.G.)
| | - Simona Simone
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (E.D.S.); (G.F.); (V.P.); (S.S.); (L.G.)
| | - Francesca Centrone
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, 70124 Bari, Italy; (D.L.); (F.C.); (M.A.)
| | - Marisa Accogli
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, 70124 Bari, Italy; (D.L.); (F.C.); (M.A.)
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (E.D.S.); (G.F.); (V.P.); (S.S.); (L.G.)
| | - Maria Chironna
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, 70124 Bari, Italy; (D.L.); (F.C.); (M.A.)
- Correspondence: ; Tel.: +39-080-5478498; Fax: +39-080-5593887
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44
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Stock PG, Henrich TJ, Segev DL, Werbel WA. Interpreting and addressing suboptimal immune responses after COVID-19 vaccination in solid-organ transplant recipients. J Clin Invest 2021; 131:e151178. [PMID: 34143755 DOI: 10.1172/jci151178] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Transplant recipients were excluded from the initial clinical trials determining safety and efficacy of the landmark COVID-19 vaccines. Further, there is increasing evidence that immunosuppressed transplant recipients have a blunted antibody response to COVID-19 vaccination. In a concerning report by Sattler et al. in this issue of the JCI, kidney transplant recipients not only lacked a humoral response following two doses of Pfizer BNT162b2, but also displayed substantial impairment of the cellular response to SARS-CoV-2 antigens. This Commentary addresses potential strategies for transplant providers to evaluate and augment vaccine immunogenicity given the likelihood that COVID-19 will remain a world-wide threat to the health of transplant recipients.
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Affiliation(s)
| | | | | | - William A Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Heeger PS, Larsen CP, Segev DL. Implications of defective immune responses in SARS-CoV-2 vaccinated organ transplant recipients. Sci Immunol 2021; 6:6/61/eabj6513. [PMID: 34210786 DOI: 10.1126/sciimmunol.abj6513] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 06/25/2021] [Indexed: 12/16/2022]
Abstract
Organ transplant patients have poor immune responses to COVID-19 vaccines; thus designing vaccine strategies to protect this vulnerable population from SARS-CoV-2 infection is crucial.
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Affiliation(s)
- Peter S Heeger
- Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Christian P Larsen
- Emory Transplant Center, Emory University School of Medicine, Atlanta, GA
| | - Dorry L Segev
- Transplant Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
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Sakhi H, Chavarot N, Attias P, El Karoui K, Anglicheau D. [COVID-19 vaccination in dialysis and kidney transplant patients]. Nephrol Ther 2021; 17:208-213. [PMID: 34305020 PMCID: PMC8245347 DOI: 10.1016/j.nephro.2021.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 06/27/2021] [Indexed: 01/04/2023]
Abstract
Au cours de la COVID-19, la dialyse et la transplantation rénale ont été identifiées comme d’importants facteurs de risque de développer une forme sévère de la maladie. La réponse immunitaire humorale post-infection est durable. Cependant, après vaccination, celle-ci apparaît plus limitée, tant en termes de taux de réponse (séropositivité post-vaccination) qu’en termes de taux quantitatif d’anticorps. Alors que les patients dialysés ont un taux de réponse de 80–95 % en fonction des études, la réponse est particulièrement faible chez les patients transplantés rénaux, avec des taux de séropositivité de 30–50 %, et notamment s’ils sont traités par bélatacept (environ 5 % de réponse). Ces éléments ont poussé à proposer des schémas vaccinaux alternatifs en France, avec notamment l’utilisation d’une 3e injection de vaccin ARNm. Malgré ces résultats, de nombreuses questions sur la vaccination des insuffisants rénaux restent en suspens, concernant notamment la qualité des réponses cellulaires (encore peu étudiées), la durabilité des réponses post-vaccinales, et surtout l’efficacité clinique des vaccins.
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Affiliation(s)
- Hamza Sakhi
- Service de néphrologie et transplantation, fédération hospitalo-universitaire « Innovative therapy for immune disorders », centre de référence maladie rare « syndrome néphrotique idiopathique », hôpitaux universitaires Henri-Mondor, Créteil, France; Équipe 21, institut national de la santé et de la recherche médicale (Inserm) U955, institut Mondor de recherche biomédicale (IMRB), université Paris-Est-Créteil, Créteil, France
| | - Nathalie Chavarot
- Service de néphrologie et transplantation, centre de référence Maladie rare MAREHA, hôpitaux universitaires Necker-Enfants malades, Paris, France
| | - Philippe Attias
- Department of nephrology and dialysis, hôpital privé Nord Parisien, Sarcelles, France
| | - Khalil El Karoui
- Service de néphrologie et transplantation, fédération hospitalo-universitaire « Innovative therapy for immune disorders », centre de référence maladie rare « syndrome néphrotique idiopathique », hôpitaux universitaires Henri-Mondor, Créteil, France; Équipe 21, institut national de la santé et de la recherche médicale (Inserm) U955, institut Mondor de recherche biomédicale (IMRB), université Paris-Est-Créteil, Créteil, France.
| | - Dany Anglicheau
- Service de néphrologie et transplantation, centre de référence Maladie rare MAREHA, hôpitaux universitaires Necker-Enfants malades, Paris, France
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