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Karaba AH, Swank Z, Hussain S, Chahoud M, Durand CM, Segev DL, Robien MA, Heeger PS, Larsen CP, Tobian AAR, Walt DR, Werbel WA. Detectable plasma severe acute respiratory syndrome coronavirus 2 spike antigen is associated with poor antibody response following third messenger RNA vaccination in kidney transplant recipients. Transpl Infect Dis 2024:e14281. [PMID: 38618895 DOI: 10.1111/tid.14281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/20/2024] [Accepted: 03/27/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Kidney transplant recipients (KTRs) generate lower antibody responses to messenger RNA (mRNA)-based severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination, yet precise mechanisms for this poor response remain uncertain. One potential contributor is suboptimal spike antigen (sAg) translation and expression owing to transplant immunosuppression, which might lead to insufficient exposure to develop humoral and/or cellular immune responses. METHODS Within a single-arm clinical trial, 65 KTRs underwent ultrasensitive plasma sAg testing before, and 3 and 14 days after, the third mRNA vaccine doses. Anti-SARS-CoV-2 spike antibodies (anti-receptor binding domain [anti-RBD]) were serially measured at 14 and 30 days post-vaccination. Associations between sAg detection and clinical factors were assessed. Day 30 anti-RBD titer was compared among those with versus without sAg expression using Wilcoxon rank sum testing. RESULTS Overall, 16 (25%) KTRs were sAg positive (sAg+) after vaccination, peaking at day 3. Clinical and laboratory factors were broadly similar in sAg(+) versus sAg(-) KTRs. sAg(+) status was significantly negatively associated with day 30 anti-RBD response, with median (interquartile range) 10.8 (<0.4-338.3) U/mL if sAg(+) versus 709 (10.5-2309.5) U/mL if sAg(-) (i.e., 66-fold lower; p = .01). CONCLUSION Inadequate plasma sAg does not likely drive poor antibody responses in KTRs, rather sAg detection implies insufficient immune response to rapidly clear vaccine antigen from blood. Other downstream mechanisms such as sAg trafficking and presentation should be explored.
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Affiliation(s)
- Andrew H Karaba
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zoe Swank
- Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, Massachusetts, USA
| | - Sarah Hussain
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Margaret Chahoud
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christine M Durand
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dorry L Segev
- Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Mark A Robien
- Transplantation Branch, Division of Allergy Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, Rockville, Maryland, USA
| | - Peter S Heeger
- Department of Medicine, Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David R Walt
- Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, Massachusetts, USA
| | - William A Werbel
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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2
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Roznik K, Xue J, Stavrakis G, Johnston TS, Kalluri D, Ohsie R, Qin CX, McAteer J, Segev DL, Mogul D, Werbel WA, Karaba AH, Thompson EA, Cox AL. COVID-19 vaccination induces distinct T-cell responses in pediatric solid organ transplant recipients and immunocompetent children. NPJ Vaccines 2024; 9:73. [PMID: 38580714 PMCID: PMC10997632 DOI: 10.1038/s41541-024-00866-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 03/19/2024] [Indexed: 04/07/2024] Open
Abstract
Immune responses to COVID-19 vaccination are attenuated in adult solid organ transplant recipients (SOTRs) and additional vaccine doses are recommended for this population. However, whether COVID-19 mRNA vaccine responses are limited in pediatric SOTRs (pSOTRs) compared to immunocompetent children is unknown. Due to SARS-CoV-2 evolution and mutations that evade neutralizing antibodies, T cells may provide important defense in SOTRs who mount poor humoral responses. Therefore, we assessed anti-SARS-CoV-2 IgG titers, surrogate neutralization, and spike (S)-specific T-cell responses to COVID-19 mRNA vaccines in pSOTRs and their healthy siblings (pHCs) before and after the bivalent vaccine dose. Despite immunosuppression, pSOTRs demonstrated humoral responses to both ancestral strain and Omicron subvariants following the primary ancestral strain monovalent mRNA COVID-19 series and multiple booster doses. These responses were not significantly different from those observed in pHCs and significantly higher six months after vaccination than responses in adult SOTRs two weeks post-vaccination. However, pSOTRs mounted limited S-specific CD8+ T-cell responses and qualitatively distinct CD4+ T-cell responses, primarily producing IL-2 and TNF with less IFN-γ production compared to pHCs. Bivalent vaccination enhanced humoral responses in some pSOTRs but did not shift the CD4+ T-cell responses toward increased IFN-γ production. Our findings indicate that S-specific CD4+ T cells in pSOTRs have distinct qualities with unknown protective capacity, yet vaccination produces cross-reactive antibodies not significantly different from responses in pHCs. Given altered T-cell responses, additional vaccine doses in pSOTRs to maintain high titer cross-reactive antibodies may be important in ensuring protection against SARS-CoV-2.
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Affiliation(s)
- Katerina Roznik
- Johns Hopkins Bloomberg School of Public Health, Department of Molecular Microbiology and Immunology, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, USA
| | - Jiashu Xue
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, USA
| | - Georgia Stavrakis
- Johns Hopkins Bloomberg School of Public Health, Department of Molecular Microbiology and Immunology, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, USA
| | - T Scott Johnston
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, USA
| | - Divya Kalluri
- Johns Hopkins University School of Medicine, Department of Surgery, Baltimore, MD, USA
| | - Rivka Ohsie
- Johns Hopkins University School of Medicine, Department of Surgery, Baltimore, MD, USA
| | - Caroline X Qin
- Johns Hopkins University School of Medicine, Department of Surgery, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, MD, USA
| | - John McAteer
- Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, MD, USA
| | - Dorry L Segev
- Johns Hopkins University School of Medicine, Department of Surgery, Baltimore, MD, USA
- NYU Grossman School of Medicine, Department of Surgery, New York, NY, USA
| | - Douglas Mogul
- Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, MD, USA
| | - William A Werbel
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, USA
| | - Andrew H Karaba
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, USA
| | - Elizabeth A Thompson
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, USA
| | - Andrea L Cox
- Johns Hopkins Bloomberg School of Public Health, Department of Molecular Microbiology and Immunology, Baltimore, MD, USA.
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, USA.
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3
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Belga S, Hussain S, Avery RK, Nauroz Z, Durand CM, King EA, Massie A, Segev DL, Connor AE, Bush EL, Levy RD, Shah P, Werbel WA. Impact of recipient age on mortality among Cytomegalovirus (CMV)-seronegative lung transplant recipients with CMV-seropositive donors. J Heart Lung Transplant 2024; 43:615-625. [PMID: 38061469 DOI: 10.1016/j.healun.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/03/2023] [Accepted: 11/26/2023] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Cytomegalovirus (CMV)-seronegative lung transplant recipients (LTRs) with seropositive donors (CMV D+/R-) have the highest mortality of all CMV serostatuses. Due to immunosenescence and other factors, we hypothesized CMV D+/R- status might disproportionately impact older LTRs. Thus, we investigated whether recipient age modified the relationship between donor CMV status and mortality among CMV-seronegative LTRs. METHODS Adult, CMV-seronegative first-time lung-only recipients were identified through the Scientific Registry of Transplant Recipients between May 2005 and December 2019. We used adjusted multivariable Cox regression to assess the relationship of donor CMV status and death. Interaction between recipient age and donor CMV was assessed via likelihood ratio testing of nested Cox models and by the relative excess risk due to interaction (RERI) and attributable proportion (AP) of joint effects. RESULTS We identified 11,136 CMV-seronegative LTRs. The median age was 59 years; 65.2% were male, with leading transplant indication of idiopathic pulmonary fibrosis (35.6%); and 60.8% were CMV D+/R-. In multivariable modeling, CMV D+/R- status was associated with 27% increased hazard of death (adjusted hazard ratio: 1.27, 95% confidence interval: 1.21-1.34) compared to CMV D-/R-. Recipient age ≥60 years significantly modified the relationship between donor CMV-seropositive status and mortality on the additive scale, including RERI 0.24 and AP 11.4% (p = 0.001), that is, the interaction increased hazard of death by 0.24 and explained 11.4% of mortality in older CMV D+ recipients. CONCLUSIONS Among CMV-seronegative LTRs, donor CMV-seropositive status confers higher risk of posttransplant mortality, which is amplified in older recipients. Future studies should define optimal strategies for CMV prevention and management in older D+/R- LTRs.
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Affiliation(s)
- Sara Belga
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
| | - Sarah Hussain
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robin K Avery
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Zeba Nauroz
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christine M Durand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elizabeth A King
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Allan Massie
- Scientific Registry of Transplant Recipients, Minneapolis, Minnesota, USA; Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Dorry L Segev
- Scientific Registry of Transplant Recipients, Minneapolis, Minnesota, USA; Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Avonne E Connor
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Errol L Bush
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert D Levy
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Pali Shah
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - William A Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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4
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Motter JD, Hussain S, Brown DM, Florman S, Rana MM, Friedman-Moraco R, Gilbert AJ, Stock P, Mehta S, Mehta SA, Stosor V, Elias N, Pereira MR, Haidar G, Malinis M, Morris MI, Hand J, Aslam S, Schaenman JM, Baddley J, Small CB, Wojciechowski D, Santos CA, Blumberg EA, Odim J, Apewokin SK, Giorgakis E, Bowring MG, Werbel WA, Desai NM, Tobian AA, Segev DL, Massie AB, Durand CM. Wait Time Advantage for Transplant Candidates With HIV Who Accept Kidneys From Donors With HIV Under the HOPE Act. Transplantation 2024; 108:759-767. [PMID: 38012862 PMCID: PMC11037099 DOI: 10.1097/tp.0000000000004857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND Kidney transplant (KT) candidates with HIV face higher mortality on the waitlist compared with candidates without HIV. Because the HIV Organ Policy Equity (HOPE) Act has expanded the donor pool to allow donors with HIV (D + ), it is crucial to understand whether this has impacted transplant rates for this population. METHODS Using a linkage between the HOPE in Action trial (NCT03500315) and Scientific Registry of Transplant Recipients, we identified 324 candidates listed for D + kidneys (HOPE) compared with 46 025 candidates not listed for D + kidneys (non-HOPE) at the same centers between April 26, 2018, and May 24, 2022. We characterized KT rate, KT type (D + , false-positive [FP; donor with false-positive HIV testing], D - [donor without HIV], living donor [LD]) and quantified the association between HOPE enrollment and KT rate using multivariable Cox regression with center-level clustering; HOPE was a time-varying exposure. RESULTS HOPE candidates were more likely male individuals (79% versus 62%), Black (73% versus 35%), and publicly insured (71% versus 52%; P < 0.001). Within 4.5 y, 70% of HOPE candidates received a KT (41% D + , 34% D - , 20% FP, 4% LD) versus 43% of non-HOPE candidates (74% D - , 26% LD). Conversely, 22% of HOPE candidates versus 39% of non-HOPE candidates died or were removed from the waitlist. Median KT wait time was 10.3 mo for HOPE versus 60.8 mo for non-HOPE candidates ( P < 0.001). After adjustment, HOPE candidates had a 3.30-fold higher KT rate (adjusted hazard ratio = 3.30, 95% confidence interval, 2.14-5.10; P < 0.001). CONCLUSIONS Listing for D + kidneys within HOPE trials was associated with a higher KT rate and shorter wait time, supporting the expansion of this practice for candidates with HIV.
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Affiliation(s)
| | - Sarah Hussain
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Diane M. Brown
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sander Florman
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Meenakshi M. Rana
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Peter Stock
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Shikha Mehta
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Sapna A. Mehta
- Department of Medicine, NYU Grossman School of Medicine, New York, NY
| | - Valentina Stosor
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nahel Elias
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Marcus R. Pereira
- Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Ghady Haidar
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Maricar Malinis
- Department of Medicine, Yale School of Medicine, New Haven, CT
| | - Michele I. Morris
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Jonathan Hand
- Department of Medicine, Ochsner Health, New Orleans, LA
| | - Saima Aslam
- Department of Medicine, University of California San Diego, La Jolla, CA
| | - Joanna M. Schaenman
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - John Baddley
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Catherine B. Small
- Department of Medicine/Division of Infectious Diseases, Weill Cornell Medicine, New York, NY
| | | | | | - Emily A. Blumberg
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Jonah Odim
- Division of Allergy, Immunology and Transplantation, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Senu K. Apewokin
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH
| | - Emmanouil Giorgakis
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Mary Grace Bowring
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - William A. Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Niraj M. Desai
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Aaron A.R. Tobian
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, NYU Grossman School of Medicine, New York, NY
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
- Scientific Registry of Transplant Recipients, Minneapolis, MN
| | - Allan B. Massie
- Department of Surgery, NYU Grossman School of Medicine, New York, NY
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
| | - Christine M. Durand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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5
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McAteer J, Kalluri DD, Abedon RR, Qin CX, Auerbach SR, Charnaya O, Danziger-Isakov LA, Ebel NH, Feldman AG, Hsu EK, Mohammad S, Perito ER, Thomas AM, Chiang TPY, Garonzik-Wang JM, Segev DL, Werbel WA, Mogul DB. Omicron Infections in Vaccinated Pediatric Solid Organ Transplant Recipients. J Pediatric Infect Dis Soc 2024; 13:152-154. [PMID: 38035755 PMCID: PMC10896257 DOI: 10.1093/jpids/piad108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Indexed: 12/02/2023]
Abstract
SARS-CoV-2 infection during the Omicron period was frequent amongst a cohort of vaccinated pediatric solid organ transplant recipients (pSOTRs) despite robust anti-receptor-binding domain (anti-RBD) antibody response, suggesting poor neutralizing capacity against Omicron subvariants. Breakthrough infections among pSOTRs were overall limited in severity.
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Affiliation(s)
- John McAteer
- Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins Children’s Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Nephrology, Department of Pediatrics, Johns Hopkins Children’s Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Divya D Kalluri
- Department of Surgery, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rivka R Abedon
- Department of Surgery, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Caroline X Qin
- Division of Nephrology, Department of Pediatrics, Johns Hopkins Children’s Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Surgery, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Scott R Auerbach
- Division of Cardiology, Department of Pediatrics, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Olga Charnaya
- Division of Nephrology, Department of Pediatrics, Johns Hopkins Children’s Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lara A Danziger-Isakov
- Division of Infectious Diseases, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Noelle H Ebel
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, USA
| | - Amy G Feldman
- Section of Gastroenterology, Hepatology and Nutrition, Digestive Health Institute, Children’s Hospital Colorado, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Evelyn K Hsu
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Saeed Mohammad
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, USA
| | - Emily R Perito
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of California San Francisco Benioff Children’s Hospital, University of California San Francisco, San Francisco, California, USA
| | - Ashley M Thomas
- Section of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Johns Hopkins Children’s Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Teresa P Y Chiang
- Department of Surgery, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Dorry L Segev
- Division of Transplant Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin, USA
| | - William A Werbel
- Department of Surgery, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Douglas B Mogul
- Section of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Johns Hopkins Children’s Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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6
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McAteer J, Kalluri DD, Abedon RR, Qin CX, Auerbach SR, Charnaya O, Danziger-Isakov LA, Ebel NH, Feldman AG, Hsu EK, Mohammad S, Perito ER, Thomas AM, Chiang TPY, Garonzik-Wang JM, Segev DL, Werbel WA, Mogul DB. Anti-spike antibody durability after SARS-CoV-2 vaccination in adolescent solid organ transplant recipients. Pediatr Transplant 2024; 28:e14671. [PMID: 38317335 DOI: 10.1111/petr.14671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/09/2023] [Accepted: 11/17/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Adolescent solid organ transplant recipients (aSOTRs) who received three doses of the COVID-19 mRNA vaccine experience high seroconversion rates and antibody persistence for up to 3 months. Long-term antibody durability beyond this timeframe following three doses of the SARS-CoV-2 mRNA vaccine remains unknown. We describe antibody responses 6 months following the third vaccine dose (D3) of the BNT162b2 mRNA vaccination among aSOTRs. METHODS Participants in a multi-center, observational cohort who received the third dose of the vaccine were analyzed for antibodies to the SARS-CoV-2 spike protein receptor-binding domain (Roche Elecsys anti-SARS-CoV-2-S positive: ≥0.8, maximum: >2500 U/mL). Samples were collected at 1-, 3-, and 6-months post-D3. Participants were surveyed at each timepoint and at 12-months post-D3. RESULTS All 34 participants had positive anti-RBD antibody titers 6 months post-D3. Variations in titers occurred between 3 and 6 months post-D3, with 8/28 (29%) having decreased antibody levels at 6 months compared to 3 months and 2/28 (7%) reporting increased titers at 6 months. The remaining 18/28 (64%) had unchanged antibody titers compared to 3-month post-D3 levels. A total of 4/34 (12%) reported breakthrough infection within 6 months and 3/32 (9%) reported infection after 6-12 months following the third dose of the SARS-CoV-2 mRNA vaccine. CONCLUSIONS The results suggest that antibody durability persists up to 6 months following three doses of the SARS-CoV-2 mRNA in aSOTRs. Demography and transplant characteristics did not differ for those who experienced antibody weaning. Breakthrough infections did occur, reflecting immune-evasive nature of novel variants such as Omicron.
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Affiliation(s)
- John McAteer
- Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Nephrology, Department of Pediatrics, Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Divya D Kalluri
- Department of Surgery, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rivka R Abedon
- Department of Surgery, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Caroline X Qin
- Department of Surgery, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Scott R Auerbach
- Division of Cardiology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Olga Charnaya
- Division of Nephrology, Department of Pediatrics, Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lara A Danziger-Isakov
- Division of Infectious Diseases, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Noelle H Ebel
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, USA
| | - Amy G Feldman
- Section of Gastroenterology, Hepatology and Nutrition, Digestive Health Institute, Children's Hospital Colorado, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Evelyn K Hsu
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Saeed Mohammad
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, USA
| | - Emily R Perito
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of California San Francisco Benioff Children's Hospital, University of California San Francisco, San Francisco, California, USA
| | - Ashley M Thomas
- Section of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Teresa P Y Chiang
- Department of Surgery, NYU Grossman School of Medicine, New York City, New York, USA
| | - Jacqueline M Garonzik-Wang
- Division of Transplant Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin, USA
| | - Dorry L Segev
- Department of Surgery, NYU Grossman School of Medicine, New York City, New York, USA
| | - William A Werbel
- Department of Surgery, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Douglas B Mogul
- Section of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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7
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Alejo JL, Chiang TPY, Frey S, Nair GA, Abedon AT, Nauroz Z, Karaba AH, Avery RK, Tobian AA, Clarke WA, Garonzik-Wang JM, Segev DL, Massie AB, Werbel WA. Letter to the editor: Poor sensitivity of anti-nucleocapsid antibody in detecting prior COVID-19 in vaccinated solid organ transplant recipients. Clin Transplant 2024; 38:e15233. [PMID: 38289891 PMCID: PMC10832987 DOI: 10.1111/ctr.15233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/04/2023] [Accepted: 12/11/2023] [Indexed: 02/01/2024]
Affiliation(s)
- Jennifer L. Alejo
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore MD
| | | | - Sarah Frey
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore MD
| | - Goutham A. Nair
- John Sealy School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX
| | - Aura T. Abedon
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore MD
| | - Zeba Nauroz
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore MD
| | - Andrew H. Karaba
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore MD
| | - Robin K. Avery
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore MD
| | - Aaron A.R. Tobian
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore MD
| | - William A. Clarke
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore MD
| | | | - Dorry L. Segev
- Department of Surgery, NYU Grossman School of Medicine, New York, NY
| | - Allan B. Massie
- Department of Surgery, NYU Grossman School of Medicine, New York, NY
| | - William A. Werbel
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore MD
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8
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Karaba AH, Morgenlander WR, Johnston TS, Hage C, Pekosz A, Durand CM, Segev DL, Robien MA, Heeger PS, Larsen CP, Blankson JN, Werbel WA, Larman HB, Tobian AAR. Epitope Mapping of SARS-CoV-2 Spike Antibodies in Vaccinated Kidney Transplant Recipients Reveals Poor Spike Coverage Compared to Healthy Controls. J Infect Dis 2023:jiad534. [PMID: 38019656 DOI: 10.1093/infdis/jiad534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/17/2023] [Accepted: 11/27/2023] [Indexed: 12/01/2023] Open
Abstract
Kidney transplant recipients (KTRs) develop decreased antibody titers to SARS-CoV-2 vaccination compared to healthy controls (HCs), but whether KTRs generate antibodies against key epitopes associated with neutralization is unknown. Plasma from 78 KTRs from a clinical trial of third doses of SARS-CoV-2 vaccines and 12 HCs underwent phage display immunoprecipitation and sequencing (PhIP-Seq) to map antibody responses against SARS-CoV-2. KTRs had lower antibody reactivity to SARS-CoV-2 than HCs, but KTRs and HCs recognized similar epitopes associated with neutralization. Thus, epitope gaps in antibody breadth of KTRs are unlikely responsible for decreased efficacy of SARS-CoV-2 vaccines in this immunosuppressed population.
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Affiliation(s)
- Andrew H Karaba
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William R Morgenlander
- Institute for Cell Engineering, Division of Immunology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Trevor S Johnston
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Camille Hage
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew Pekosz
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Christine M Durand
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dorry L Segev
- Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Mark A Robien
- Transplantation Branch, Division of Allergy Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, Rockville, MD, USA
| | - Peter S Heeger
- Department of Medicine, Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles CA, USA
| | | | - Joel N Blankson
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William A Werbel
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - H Benjamin Larman
- Institute for Cell Engineering, Division of Immunology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aaron A R Tobian
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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9
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Tsipotis E, Maremanda A, Zeiser LB, Connolly C, Sharma S, Dudley-Brown S, Frey S, Lazarev M, Melia JM, Parian AM, Segev DL, Truta B, Yu H, Werbel WA, Selaru FM. Antibody Kinetics after Three Doses of SARS-CoV-2 mRNA Vaccination in Patients with Inflammatory Bowel Disease. Medicina (Kaunas) 2023; 59:1487. [PMID: 37629777 PMCID: PMC10456461 DOI: 10.3390/medicina59081487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/31/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
Background: The emergence of new SARS-CoV-2 variants calls for more data on SARS-CoV-2 mRNA vaccine response. Aims: We aimed to assess the response to a third mRNA vaccine dose against SARS-CoV-2 in inflammatory bowel disease (IBD) patients. Methods: This was a single-center, observational prospective study of IBD patients who received a third mRNA vaccine dose against SARS-CoV-2. Antibody titers were taken post-third-dose at one and three months using the Roche Elecsys anti-SARS-CoV-2-S enzyme immunoassay. Titers less than 0.8 units/mL were considered negative according to the manufactures. Titers between 0.8 units/mL and 250 units/mL were considered non-neutralizing. Titers greater than 250 units/mL were considered neutralizing. Results: Eighty-three patients were included, all of whom had detectable antibodies at 3 months post-third dose. A total of 89% showed neutralizing and 11% non-neutralizing titers. Participants with non-neutralizing titers were more likely to be on systemic corticosteroids (p = 0.04). Two participants seroconverted from negative to positive, whereas 86% with non-neutralizing titers boosted to neutralizing levels. Only one participant with neutralizing titers after a third dose had a decrease to a non-neutralizing level within 3 months. Conclusions: Our findings support the ongoing recommendations for additional doses in immunocompromised individuals. However, longitudinal studies with a greater-sized patient population are needed.
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Affiliation(s)
| | - Ankith Maremanda
- Hopkins IBD Center, Division of Gastroenterology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA; (A.M.); (S.S.); (S.D.-B.); (M.L.); (J.M.M.); (A.M.P.); (B.T.); (H.Y.)
| | - Laura Bowles Zeiser
- Department of Surgery, NYU Grossman School of Medicine, New York, NY 10016, USA;
| | - Caoilfhionn Connolly
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA;
| | - Sowmya Sharma
- Hopkins IBD Center, Division of Gastroenterology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA; (A.M.); (S.S.); (S.D.-B.); (M.L.); (J.M.M.); (A.M.P.); (B.T.); (H.Y.)
| | - Sharon Dudley-Brown
- Hopkins IBD Center, Division of Gastroenterology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA; (A.M.); (S.S.); (S.D.-B.); (M.L.); (J.M.M.); (A.M.P.); (B.T.); (H.Y.)
| | - Sarah Frey
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA;
| | - Mark Lazarev
- Hopkins IBD Center, Division of Gastroenterology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA; (A.M.); (S.S.); (S.D.-B.); (M.L.); (J.M.M.); (A.M.P.); (B.T.); (H.Y.)
| | - Joanna M. Melia
- Hopkins IBD Center, Division of Gastroenterology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA; (A.M.); (S.S.); (S.D.-B.); (M.L.); (J.M.M.); (A.M.P.); (B.T.); (H.Y.)
| | - Alyssa M. Parian
- Hopkins IBD Center, Division of Gastroenterology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA; (A.M.); (S.S.); (S.D.-B.); (M.L.); (J.M.M.); (A.M.P.); (B.T.); (H.Y.)
| | - Dorry L. Segev
- Department of Surgery Center for Surgical and Transplant Applied Research, NYU Langone Health, New York, NY 10016, USA;
| | - Brindusa Truta
- Hopkins IBD Center, Division of Gastroenterology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA; (A.M.); (S.S.); (S.D.-B.); (M.L.); (J.M.M.); (A.M.P.); (B.T.); (H.Y.)
| | - Huimin Yu
- Hopkins IBD Center, Division of Gastroenterology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA; (A.M.); (S.S.); (S.D.-B.); (M.L.); (J.M.M.); (A.M.P.); (B.T.); (H.Y.)
| | - William A. Werbel
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Florin M. Selaru
- Hopkins IBD Center, Division of Gastroenterology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA; (A.M.); (S.S.); (S.D.-B.); (M.L.); (J.M.M.); (A.M.P.); (B.T.); (H.Y.)
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD 21224, USA
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10
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Chiang TPY, Abedon AT, Alejo JL, Segev DL, Massie AB, Werbel WA. Incident COVID-19 and Hospitalizations by Variant Era Among Vaccinated Solid Organ Transplant Recipients. JAMA Netw Open 2023; 6:e2329736. [PMID: 37594763 PMCID: PMC10439474 DOI: 10.1001/jamanetworkopen.2023.29736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 07/12/2023] [Indexed: 08/19/2023] Open
Abstract
This cohort study evaluates the incidence of COVID-19 and hospitalizations across variant eras in 2021 and 2022 among vaccinated solid organ transplant (SOT) recipients.
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Affiliation(s)
| | - Aura T. Abedon
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer L. Alejo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dorry L. Segev
- Department of Surgery, NYU Grossman School of Medicine, New York
| | - Allan B. Massie
- Department of Surgery, NYU Grossman School of Medicine, New York
| | - William A. Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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11
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Abedon AT, Chiang TPY, Karaba AH, Alejo JL, Chahoud M, Hussey C, Lopes JF, Hussain S, Larsen CP, Durand CM, Heeger PS, Segev DL, Clarke WA, Werbel WA. Letter to the editor: "hook" (prozone) effect in sars-cov-2 anti-spike binding antibody levels following vaccination, infection, or monoclonal antibody in solid organ transplant recipients. Clin Transplant 2023; 37:e15044. [PMID: 37329291 PMCID: PMC10528109 DOI: 10.1111/ctr.15044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/25/2023] [Indexed: 06/19/2023]
Abstract
Anti-spike binding antibody (Ab) levels are used by some providers to inform COVID-19 risk assessment for solid organ transplant recipients (SOTRs). As has been observed with other Ab assays, in the setting of high binding Ab, quantitative results may demonstrate artifactually low values (i.e., “hook” or prozone effect). Within two studies of SARS-CoV-2 vaccination of SOTRs (an observational cohort and a single-center trial), Ab levels were assessed using the semiquantitative Roche Elecsys anti-SARS-CoV-2 S assay. In the observational cohort, we flagged 9 samples with either a paradoxical decrease or weak (<10x) rise after Tixagevimab/Cilgavimab (T/C) administration. This prompted retesting with up-front 1:50 dilution, with serial dilution performed until returning two results within expected assay variation. Subsequently, all post-vaccination clinical trial samples were retested. Hook effect was suspected if retest level was both ≥15% and ≥200U/mL higher than original level. From the observational cohort, all 9 flagged samples demonstrated a hook effect. Of 377 clinical trial samples (all rerun), 34/377 (9%) demonstrated a hook effect. Among the hook effect samples (n=43), the original median (IQR) titer was 1950 (650 – 4390) U/mL, and upon retesting this increased to 5685 (2981 – 9853) U/mL representing a 1.6 (1.3–6.0)-fold increase (p=0.03). Marked hook effect (>700x increase) was observed in two participants with recent vaccination plus breakthrough infection. Hook effect was observed in SOTRs tested using a SARS-CoV-2 clinical Ab assay in the setting of high analyte. Laboratories and clinicians should be aware of this artifact and consider serial dilution to confirm accurate quantitative results.
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Affiliation(s)
- Aura T Abedon
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Teresa P Y Chiang
- Department of Surgery, NYU Grossman School of Medicine, Langone Health, New York, New York, USA
| | - Andrew H Karaba
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer L Alejo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Margaret Chahoud
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Casey Hussey
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jessica F Lopes
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sarah Hussain
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Christine M Durand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Peter S Heeger
- Department of Medicine, Cedars-Sinai Medical Center, West Hollywood, California, USA
| | - Dorry L Segev
- Department of Surgery, NYU Grossman School of Medicine, Langone Health, New York, New York, USA
| | - William A Clarke
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - William A Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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12
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Werbel WA, Karaba AH, Chiang TPY, Massie AB, Brown DM, Watson N, Chahoud M, Thompson EA, Johnson AC, Avery RK, Cochran WV, Warren D, Liang T, Fribourg M, Huerta C, Samaha H, Klein SL, Bettinotti MP, Clarke WA, Sitaras I, Rouphael N, Cox AL, Bailey JR, Pekosz A, Tobian AAR, Durand CM, Bridges ND, Larsen CP, Heeger PS, Segev DL. Persistent SARS-CoV-2-specific immune defects in kidney transplant recipients following third mRNA vaccine dose. Am J Transplant 2023; 23:744-758. [PMID: 36966905 PMCID: PMC10037915 DOI: 10.1016/j.ajt.2023.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 03/26/2023]
Abstract
Kidney transplant recipients (KTRs) show poorer response to SARS-CoV-2 mRNA vaccination, yet response patterns and mechanistic drivers following third doses are ill-defined. We administered third monovalent mRNA vaccines to n = 81 KTRs with negative or low-titer anti-receptor binding domain (RBD) antibody (n = 39 anti-RBDNEG; n = 42 anti-RBDLO), compared with healthy controls (HCs, n = 19), measuring anti-RBD, Omicron neutralization, spike-specific CD8+%, and SARS-CoV-2-reactive T cell receptor (TCR) repertoires. By day 30, 44% anti-RBDNEG remained seronegative; 5% KTRs developed BA.5 neutralization (vs 68% HCs, P < .001). Day 30 spike-specific CD8+% was negative in 91% KTRs (vs 20% HCs; P = .07), without correlation to anti-RBD (rs = 0.17). Day 30 SARS-CoV-2-reactive TCR repertoires were detected in 52% KTRs vs 74% HCs (P = .11). Spike-specific CD4+ TCR expansion was similar between KTRs and HCs, yet KTR CD8+ TCR depth was 7.6-fold lower (P = .001). Global negative response was seen in 7% KTRs, associated with high-dose MMF (P = .037); 44% showed global positive response. Of the KTRs, 16% experienced breakthrough infections, with 2 hospitalizations; prebreakthrough variant neutralization was poor. Absent neutralizing and CD8+ responses in KTRs indicate vulnerability to COVID-19 despite 3-dose mRNA vaccination. Lack of neutralization despite CD4+ expansion suggests B cell dysfunction and/or ineffective T cell help. Development of more effective KTR vaccine strategies is critical. (NCT04969263).
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Affiliation(s)
- William A Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - Andrew H Karaba
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Teresa Po-Yu Chiang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Allan B Massie
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA; Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Diane M Brown
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Natasha Watson
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Maggie Chahoud
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth A Thompson
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Robin K Avery
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Willa V Cochran
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel Warren
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tao Liang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Miguel Fribourg
- Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Hady Samaha
- Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Sabra L Klein
- Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Maria P Bettinotti
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - William A Clarke
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ioannis Sitaras
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nadine Rouphael
- Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Andrea L Cox
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Medicine, Emory University, Atlanta, Georgia, USA; Bloomberg Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Justin R Bailey
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christine M Durand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nancy D Bridges
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Peter S Heeger
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dorry L Segev
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA; Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
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13
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Connolly CM, Karaba AH, Po-Yu Chiang T, Teles M, Kim JD, Scott Johnson T, Alejo JL, Segev DL, Christopher-Stine L, Werbel WA, Paik JJ. Low Omicron BA.4 and BA.5 neutralising activity and breakthrough COVID-19 following pre-exposure prophylaxis with tixagevimab plus cilgavimab in vaccinated patients with autoimmune disease. Clin Exp Rheumatol 2023; 41:1202-1203. [PMID: 36826787 DOI: 10.55563/clinexprheumatol/pfli7o] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/16/2023] [Indexed: 02/25/2023]
Affiliation(s)
- Caoilfhionn M Connolly
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew H Karaba
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Teresa Po-Yu Chiang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mayan Teles
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jake D Kim
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Trevor Scott Johnson
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer L Alejo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dorry L Segev
- Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Lisa Christopher-Stine
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William A Werbel
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Julie J Paik
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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14
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Thompson EA, Ngecu W, Stoddart L, Johnston TS, Chang A, Cascino K, Alejo JL, Abedon AT, Samaha H, Rouphael N, Tobian AA, Segev DL, Werbel WA, Karaba AH, Blankson JN, Cox AL. Heterologous versus homologous boosting regimens elicit qualitatively distinct, BA.5-cross reactive T cells in transplant recipients. JCI Insight 2023; 8:168470. [PMID: 37104041 DOI: 10.1172/jci.insight.168470] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/12/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND The Omicron BA.5 subvariant of SARS-CoV-2 markedly escapes neutralizing antibodies induced by vaccination due to mutations in the Spike (S) protein. Solid organ transplant recipients (SOTRs) suffer high COVID-19 morbidity and demonstrate poor Omicron strain recognition after COVID-19 vaccination. T cell responses may provide a crucial second line of defense. Therefore, it is critical to understand which vaccine regimens induce robust, conserved T cell responses. METHODS We evaluated anti-S IgG titers, subvariant pseudo-neutralization, and S-specific CD4+ and CD8+ T cell responses from SOTRs in a national, prospective observational trial (n=75). Participants were selected if they received 3 doses of mRNA (homologous boosting) or two doses of mRNA followed by Ad26.COV2.S (heterologous boosting). RESULTS Homologous boosting with three mRNA doses induced the highest anti-S IgG titers. However, antibodies induced by both vaccine regimens demonstrated significantly lower pseudo-neutralization against BA.5 compared to the ancestral strain. In contrast, vaccine-induced S-specific T cells maintained cross-reactivity against BA.5 compared to ancestral recognition. Homologous boosting induced higher frequencies of activated polyfunctional CD4+ T cell responses, with polyfunctional IL-21+ peripheral T follicular helper cells increased in mRNA-1273 compared to BNT¬¬162b2. IL-21+ cells robustly correlated with antibody titers. Heterologous boosting with Ad26.COV2.S did not increase CD8+ responses compared to homologous boosting. CONCLUSIONS These data demonstrate that boosting with the ancestral strain can induce cross-reactive T cell responses against emerging variants of concern in SOTRs, but alterative vaccine strategies are required to induce robust CD8+ T cell responses. TRIAL REGISTRATION IRB00248540FUNDING. U01AI138897, U54CA260492, Emory COVID-19 research repository.
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Affiliation(s)
- Elizabeth A Thompson
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Wabathi Ngecu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Laila Stoddart
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - T Scott Johnston
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Amy Chang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Katherine Cascino
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Jennifer L Alejo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Aura T Abedon
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Hady Samaha
- Hope Clinic, Infectious Diseases Division, Emory University, Decatur, United States of America
| | - Nadine Rouphael
- Hope Clinic, Infectious Diseases Division, Emory Unviversity, Decatur, United States of America
| | - Aaron Ar Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Dorry L Segev
- Department of Surgery, NYU Grossman School of Medicine, New York, United States of America
| | - William A Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Andrew H Karaba
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Joel N Blankson
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Andrea L Cox
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States of America
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15
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Alejo JL, Kim JD, Chiang TPY, Avery RK, Karaba AH, Jefferis A, Warren DS, Massie AB, Tobian AA, Segev DL, Werbel WA. Patient-reported outcomes after Tixagevimab and Cilgavimab pre-exposure prophylaxis among solid organ transplant recipients: Safety, effectiveness, and perceptions of risk. Clin Transplant 2023; 37:e14913. [PMID: 36651598 PMCID: PMC10089940 DOI: 10.1111/ctr.14913] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/28/2022] [Accepted: 01/05/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND Tixagevimab and Cilgavimab (T + C) is authorized for pre-exposure prophylaxis (PrEP) against Coronavirus Disease 2019 (COVID-19) in solid organ transplant recipients (SOTRs), yet patient-reported outcomes after injection are not well described. Furthermore, changes in risk tolerance after T + C PrEP have not been reported, of interest given uncertain activity against emerging Omicron sublineages. METHODS Within a national prospective observational study, SOTRs who reported receiving T + C were surveyed for 3 months to ascertain: (1) local and systemic reactogenicity, (2) severe adverse events with focus on cardiovascular and alloimmune complications, and (3) breakthrough COVID-19, contextualized through (4) changes in attitudes regarding COVID-19 risk and behaviors. RESULTS At 7 days postinjection, the most common reactions were mild fatigue (29%), headache (20%), and pain at injection sites (18%). Severe adverse events were uncommon; over 3 months of follow-up, 4/392 (1%) reported acute rejection and one (.3%) reported a myocardial infarction. Breakthrough COVID-19 occurred in 9%, 16-129 days after receiving full dose (300/300 mg) T + C, including two non-ICU hospitalizations. Most surveyed SOTRs (65%) felt T + C PrEP was likely to reduce their COVID-19 risk, and 70% reported increased willingness to engage in social activities such as visiting friends. However, few felt safe to return to in-person work (20%) or cease public mask-wearing (15%). CONCLUSIONS In this prospective study of patient-reported outcomes, T + C was well tolerated with few serious events. Several COVID-19 breakthroughs were reported, notable as most SOTRs reported changes in risk tolerance after T + C. These results aid counseling of SOTRs regarding real-world safety and effectiveness of T + C.
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Affiliation(s)
- Jennifer L. Alejo
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore MD
| | - Jake D. Kim
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore MD
| | - Teresa PY Chiang
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore MD
| | - Robin K. Avery
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore MD
| | - Andrew H. Karaba
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore MD
| | - Alexa Jefferis
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore MD
| | - Daniel S. Warren
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore MD
| | - Allan B. Massie
- Department of Surgery, New York University Grossman School of Medicine, New York, NY
| | - Aaron A.R. Tobian
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore MD
| | - Dorry L. Segev
- Department of Surgery, New York University Grossman School of Medicine, New York, NY
| | - William A. Werbel
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore MD
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16
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Werbel WA, Weld ED, Advani SD, Patel PK, Sundaram ME, Phadke VK. Your outpatient has COVID-19: what are their treatment options in the current SARS-CoV-2 variant climate? Clin Infect Dis 2023:7097790. [PMID: 36999905 DOI: 10.1093/cid/ciad178] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 04/01/2023] Open
Abstract
Mutations accumulated by novel SARS-CoV-2 Omicron sublineages contribute to evasion of previously effective monoclonal antibodies for treatment or prevention of COVID-19. Other authorized or approved antiviral drugs such as nirmatrelvir/ritonavir, remdesivir, and molnupiravir are, however, predicted to maintain activity against these sublineages and are key tools to reduce severe COVID-19 outcomes in vulnerable populations. A stepwise approach may be taken to target the appropriate antiviral drug to the appropriate patient, beginning with identifying whether a patient is at high risk for hospitalization or other complications of COVID-19. Among higher-risk individuals, patient profile (including factors such as age, organ function, and comedications) and antiviral drug access inform suitable antiviral drug selection. When applied in targeted fashion, these therapies serve as a complement to vital ongoing non-pharmaceutical interventions and vaccination strategies that reduce morbidity and maximize protection against COVID-19.
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Affiliation(s)
- William A Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ethel D Weld
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sonali D Advani
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | | | | | - Varun K Phadke
- Department of Medicine, Emory University School of Medicine, Atlanta, MD, USA
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17
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Karaba AH, Kim JD, Chiang TPY, Alejo JL, Sitaras I, Abedon AT, Eby Y, Johnston TS, Li M, Aytenfisu T, Hussey C, Jefferis A, Fortune N, Abedon R, Thomas L, Habtehyimer F, Ruff J, Warren DS, Avery RK, Clarke WA, Pekosz A, Massie AB, Tobian AAR, Segev DL, Werbel WA. Neutralizing activity and 3-month durability of tixagevimab and cilgavimab prophylaxis against Omicron sublineages in transplant recipients. Am J Transplant 2023; 23:423-428. [PMID: 36906295 PMCID: PMC9835002 DOI: 10.1016/j.ajt.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 10/27/2022] [Accepted: 11/04/2022] [Indexed: 01/14/2023]
Abstract
Neutralizing antibody (nAb) responses are attenuated in solid organ transplant recipients (SOTRs) despite severe acute respiratory syndrome-coronavirus-2 vaccination. Preexposure prophylaxis (PrEP) with the antibody combination tixagevimab and cilgavimab (T+C) might augment immunoprotection, yet in vitro activity and durability against Omicron sublineages BA.4/5 in fully vaccinated SOTRs have not been delineated. Vaccinated SOTRs, who received 300 + 300 mg T+C (ie, full dose), within a prospective observational cohort submitted pre and postinjection samples between January 31, 2022, and July 6, 2022. The peak live virus nAb was measured against Omicron sublineages (BA.1, BA.2, BA.2.12.1, and BA.4), and surrogate neutralization (percent inhibition of angiotensin-converting enzyme 2 receptor binding to full length spike, validated vs live virus) was measured out to 3 months against sublineages, including BA.4/5. With live virus testing, the proportion of SOTRs with any nAb increased against BA.2 (47%-100%; P < .01), BA.2.12.1 (27%-80%; P < .01), and BA.4 (27%-93%; P < .01), but not against BA.1 (40%-33%; P = .6). The proportion of SOTRs with surrogate neutralizing inhibition against BA.5, however, fell to 15% by 3 months. Two participants developed mild severe acute respiratory syndrome-coronavirus-2 infection during follow-up. The majority of fully vaccinated SOTRs receiving T+C PrEP achieved BA.4/5 neutralization, yet nAb activity commonly waned by 3 months postinjection. It is critical to assess the optimal dose and interval of T+C PrEP to maximize protection in a changing variant climate.
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Affiliation(s)
- Andrew H Karaba
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jake D Kim
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Teresa P-Y Chiang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer L Alejo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ioannis Sitaras
- Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Aura T Abedon
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yolanda Eby
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Trevor Scott Johnston
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Maggie Li
- Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tihitina Aytenfisu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Casey Hussey
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alexa Jefferis
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicole Fortune
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rivka Abedon
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Letitia Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Feben Habtehyimer
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jessica Ruff
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel S Warren
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robin K Avery
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - William A Clarke
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew Pekosz
- Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - William A Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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18
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Teles MS, Lushniak S, Chiang TPY, Bailey JR, Gebo KA, Karaba AH, Durand CM, Segev DL, Connolly CM, Werbel WA. Immunogenicity and Reactogenicity Following 2- and 3-Dose SARS-CoV-2 Vaccination in Persons With HIV. J Acquir Immune Defic Syndr 2023; 92:e3-e6. [PMID: 36476571 PMCID: PMC9743179 DOI: 10.1097/qai.0000000000003112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Mayan S. Teles
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stephanie Lushniak
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Teresa Po-Yu Chiang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Justin R. Bailey
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kelly A. Gebo
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Andrew H. Karaba
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christine M. Durand
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
- Department of Surgery, NYU Grossman School of Medicine, New York, NY
| | - Caoilfhionn M. Connolly
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - William A. Werbel
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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19
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Mitchell J, Chiang TP, Alejo JL, Kim JD, Chang A, Abedon AT, Avery RK, Tobian AAR, Levan ML, Warren DS, Garonzik-Wang JM, Segev DL, Massie AB, Werbel WA. 6-month antibody kinetics and durability after four doses of a SARS-CoV-2 vaccine in solid organ transplant recipients. Clin Transplant 2023; 37:e14868. [PMID: 36437691 DOI: 10.1111/ctr.14868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Jonathan Mitchell
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Teresa Py Chiang
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer L Alejo
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jake D Kim
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Amy Chang
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aura T Abedon
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robin K Avery
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aaron A R Tobian
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Macey L Levan
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Daniel S Warren
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jacqueline M Garonzik-Wang
- Department of Surgery, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Dorry L Segev
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Allan B Massie
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - William A Werbel
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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20
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Bae S, Alejo JL, Chiang TP, Werbel WA, Tobian AA, Moore LW, Guha A, Huang HJ, Knight RJ, Gaber AO, Ghobrial RM, McAdams-DeMarco MA, Segev DL. mTOR inhibitors, mycophenolates, and other immunosuppression regimens on antibody response to SARS-CoV-2 mRNA vaccines in solid organ transplant recipients. Am J Transplant 2022; 22:3137-3142. [PMID: 35869809 PMCID: PMC9350033 DOI: 10.1111/ajt.17158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/24/2022] [Accepted: 07/16/2022] [Indexed: 01/25/2023]
Abstract
A recent study concluded that SARS-CoV-2 mRNA vaccine responses were improved among transplant patients taking mTOR inhibitors (mTORi). This could have profound implications for vaccine strategies in transplant patients; however, limitations in the study design raise concerns about the conclusions. To address this issue more robustly, in a large cohort with appropriate adjustment for confounders, we conducted various regression- and machine learning-based analyses to compare antibody responses by immunosuppressive agents in a national cohort (n = 1037). MMF was associated with significantly lower odds of positive antibody response (aOR = 0.09 0.130.18 ). Consistent with the recent mTORi study, the odds tended to be higher with mTORi (aOR = 1.00 1.452.13 ); however, importantly, this seemingly protective tendency disappeared (aOR = 0.47 0.731.12 ) after adjusting for MMF. We repeated this comparison by combinations of immunosuppression agents. Compared to MMF + tacrolimus, MMF-free regimens were associated with higher odds of positive antibody response (aOR = 2.39 4.267.92 for mTORi+tacrolimus; 2.34 5.5415.32 for mTORi-only; and 6.78 10.2515.93 for tacrolimus-only), whereas MMF-including regimens were not, regardless of mTORi use (aOR = 0.81 1.542.98 for MMF + mTORi; and 0.81 1.512.87 for MMF-only). We repeated these analyses in an independent cohort (n = 512) and found similar results. Our study demonstrates that the recently reported findings were confounded by MMF, and that mTORi is not independently associated with improved vaccine responses.
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Affiliation(s)
- Sunjae Bae
- Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Jennifer L. Alejo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Teresa P.Y. Chiang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - William A. Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aaron A.R. Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Linda W. Moore
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
- JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Ashrith Guha
- JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, Texas, USA
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Howard J. Huang
- JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, Texas, USA
- Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Richard J. Knight
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
- JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, Texas, USA
| | - A. Osama Gaber
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
- JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, Texas, USA
| | - R. Mark Ghobrial
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
- JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Mara A. McAdams-DeMarco
- Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Dorry L. Segev
- Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
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21
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Alejo JL, Ruck JM, Chiang TPY, Abedon AT, Kim JD, Avery RK, Tobian AAR, Warren DS, Levan ML, Massie AB, Garonzik‐Wang JM, Segev DL, Werbel WA. Antibody response to a third dose of SARS-CoV-2 vaccine in heart and lung transplant recipients. Clin Transplant 2022; 36:e14818. [PMID: 36073912 PMCID: PMC9538949 DOI: 10.1111/ctr.14818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/17/2022] [Accepted: 09/05/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Jennifer L. Alejo
- Department of SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Jessica M. Ruck
- Department of SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Teresa P. Y. Chiang
- Department of SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Aura T. Abedon
- Department of SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Jake D. Kim
- Department of SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Robin K. Avery
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Aaron A. R. Tobian
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Daniel S. Warren
- Department of SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Macey L. Levan
- Department of SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of SurgeryNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Allan B. Massie
- Department of SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of SurgeryNYU Grossman School of MedicineNew YorkNew YorkUSA
| | | | - Dorry L. Segev
- Department of SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of SurgeryNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - William A. Werbel
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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22
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Mitchell J, Connolly CM, Po-Yu Chiang T, Alejo JL, Werbel WA, Segev DL, Massie AB. 249.8: SARS-coV-2 Antibody Response by mRNA Vaccine Platform in Incrementally Immunosuppressed Patients. Transplantation 2022. [DOI: 10.1097/01.tp.0000886312.95348.9e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Chiang TPY, Alejo JL, Mitchell J, Kim JD, Abedon AT, Karaba AH, Thomas L, Levan ML, Garonzik-Wang JM, Avery RK, Pekosz A, Clarke WA, Warren DS, Tobian AA, Massie AB, Segev DL, Werbel WA. Heterologous Ad.26.COV2.S versus homologous BNT162b2/mRNA-1273 as a third dose in solid organ transplant recipients seronegative after two-dose mRNA vaccination. Am J Transplant 2022; 22:2254-2260. [PMID: 35429211 PMCID: PMC9111240 DOI: 10.1111/ajt.17061] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 01/25/2023]
Abstract
Heterologous vaccination ("mixing platforms") for the third (D3) dose of SARS-CoV-2 vaccine is a potential strategy to improve antibody responses in solid organ transplant recipients (SOTRs), but data are mixed regarding potential differential immunogenicity. We assessed for differences in immunogenicity and tolerability of homologous (BNT162b2 or mRNA-1273; D3-mRNA) versus heterologous (Ad.26.COV2.S; D3-JJ) D3 among 377 SARS-CoV-2-infection naïve SOTRs who remained seronegative after two mRNA vaccines. We measured anti-spike titers and used weighted Poisson regression to evaluate seroconversion and development of high-titers, comparing D3-JJ to D3-mRNA, at 1-, 3-, and 6 month post-D3. 1-month post-D3, seroconversion (63% vs. 52%, p = .3) and development of high-titers (29% vs. 25%, p = .7) were comparable between D3-JJ and D3-mRNA recipients. 3 month post-D3, D3-JJ recipients were 1.4-fold more likely to seroconvert (80% vs. 57%, weighted incidence-rate-ratio: wIRR = 1.10 1.401.77 , p = .006) but not more likely to develop high-titers (27% vs. 22%, wIRR = 0.44 0.921.93 , p = .8). 6 month post-D3, D3-JJ recipients were 1.41-fold more likely to seroconvert (88% vs. 59%, wIRR = 1.04 1.411.93 , p = .029) and 2.63-fold more likely to develop high-titers (59% vs. 21%, wIRR = 1.38 2.635.00 , p = .003). There was no differential signal in alloimmune events or reactogenicity between platforms. SOTRs without antibody response after two mRNA vaccines may derive benefit from heterologous Ad.26.COV2.S D3.
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Affiliation(s)
- Teresa PY Chiang
- Department of Surgery The Johns Hopkins University School of Medicine Baltimore, Maryland USA
| | - Jennifer L. Alejo
- Department of Surgery The Johns Hopkins University School of Medicine Baltimore, Maryland USA
| | - Jonathan Mitchell
- Department of Surgery The Johns Hopkins University School of Medicine Baltimore, Maryland USA
| | - Jake D. Kim
- Department of Surgery The Johns Hopkins University School of Medicine Baltimore, Maryland USA
| | - Aura T. Abedon
- Department of Surgery The Johns Hopkins University School of Medicine Baltimore, Maryland USA
| | - Andrew H. Karaba
- Department of Medicine The Johns Hopkins University School of Medicine Baltimore, Maryland USA
| | - Letitia Thomas
- Department of Surgery The Johns Hopkins University School of Medicine Baltimore, Maryland USA
| | - Macey L. Levan
- Department of Surgery The Johns Hopkins University School of Medicine Baltimore, Maryland USA,Department of Acute and Chronic Care Johns Hopkins University School of Nursing Baltimore, Maryland USA,Department of Surgery NYU Grossman School of Medicine NYU Langone Health New York, New York USA
| | | | - Robin K. Avery
- Department of Medicine The Johns Hopkins University School of Medicine Baltimore, Maryland USA
| | - Andrew Pekosz
- Department of Molecular Microbiology and Immunology Johns Hopkins University Bloomberg School of Public Health Baltimore, Maryland USA
| | - William A. Clarke
- Department of Pathology The Johns Hopkins University School of Medicine Baltimore, Maryland USA
| | - Daniel S. Warren
- Department of Surgery The Johns Hopkins University School of Medicine Baltimore, Maryland USA
| | - Aaron A.R. Tobian
- Department of Pathology The Johns Hopkins University School of Medicine Baltimore, Maryland USA
| | - Allan B. Massie
- Department of Surgery The Johns Hopkins University School of Medicine Baltimore, Maryland USA,Department of Surgery NYU Grossman School of Medicine NYU Langone Health New York, New York USA,Department of Epidemiology Johns Hopkins School of Public Health Baltimore, Maryland USA
| | - Dorry L. Segev
- Department of Surgery The Johns Hopkins University School of Medicine Baltimore, Maryland USA,Department of Surgery NYU Grossman School of Medicine NYU Langone Health New York, New York USA,Department of Epidemiology Johns Hopkins School of Public Health Baltimore, Maryland USA,Dorry Segev, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | - William A. Werbel
- Department of Medicine The Johns Hopkins University School of Medicine Baltimore, Maryland USA
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24
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Frey S, Ruck JM, Alejo JL, Barker L, Matthew J, Werbel WA, Avery RK, Segev DL, Shah PD. Perivaccination Antimetabolite Hold and Third Dose of SARS-CoV-2 Vaccine in Lung Transplant Recipients: Preliminary Report. Transplantation 2022; 106:e426-e428. [PMID: 35698264 PMCID: PMC10123514 DOI: 10.1097/tp.0000000000004240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Sarah Frey
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jessica M. Ruck
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jennifer L. Alejo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lindsay Barker
- Division of Pulmonology and Critical Care, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joby Matthew
- Division of Pulmonology and Critical Care, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Robin K. Avery
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Surgery, New York University, New York, NY
| | - Pali D. Shah
- Division of Pulmonology and Critical Care, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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25
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Karaba AH, Zhou W, Li S, Aytenfisu TY, Johnston TS, Akinde O, Eby Y, Abedon AT, Alejo JL, Qin CX, Thompson EA, Garonzik-Wang JM, Blankson JN, Cox AL, Bailey JR, Klein SL, Pekosz A, Segev DL, Tobian AAR, Werbel WA. Impact of Seasonal Coronavirus Antibodies on Severe Acute Respiratory Syndrome Coronavirus 2 Vaccine Responses in Solid Organ Transplant Recipients. Clin Infect Dis 2022; 76:e495-e498. [PMID: 35959783 PMCID: PMC9384709 DOI: 10.1093/cid/ciac652] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/01/2022] [Accepted: 08/09/2022] [Indexed: 12/03/2022] Open
Abstract
Antibody responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination are reduced in solid organ transplant recipients (SOTRs). We report that increased levels of preexisting antibodies to seasonal coronaviruses are associated with decreased antibody response to SARS-CoV-2 vaccination in SOTRs, supporting that antigenic imprinting modulates vaccine responses in SOTRs.
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Affiliation(s)
- Andrew H Karaba
- Corresponding Author: Andrew H. Karaba 855 N. Wolfe St. Rangos 530A Baltimore, MD, 21205 United States of America
| | - Weiqiang Zhou
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shuai Li
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tihitina Y Aytenfisu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Trevor S Johnston
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Olivia Akinde
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yolanda Eby
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aura T Abedon
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer L Alejo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Caroline X Qin
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth A Thompson
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Joel N Blankson
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrea L Cox
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA,W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health,Baltimore, MD, USA,Bloomberg Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Justin R Bailey
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sabra L Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health,Baltimore, MD, USA
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health,Baltimore, MD, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William A Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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26
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Strauss AT, Chang A, Alejo JL, Chiang TP, Hernandez NF, Zeiser LB, Boyarsky BJ, Avery RK, Tobian AAR, Levan ML, Warren DS, Massie AB, Garonzik‐Wang JM, Segev DL, Werbel WA. Severe acute respiratory syndrome coronavirus 2 antibody response to a third dose of homologous messenger RNA vaccination in liver transplantation recipients. Liver Transpl 2022; 28:1393-1396. [PMID: 35389558 PMCID: PMC9088577 DOI: 10.1002/lt.26472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/11/2022] [Accepted: 03/17/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Alexandra T. Strauss
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Amy Chang
- Department of SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Jennifer L. Alejo
- Department of SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Teresa P.‐Y. Chiang
- Department of SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Nicole F. Hernandez
- Department of SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Laura B. Zeiser
- Department of SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Brian J. Boyarsky
- Department of SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Robin K. Avery
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Aaron A. R. Tobian
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Macey L. Levan
- Department of SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Acute and Chronic CareJohns Hopkins University School of NursingBaltimoreMarylandUSA
| | - Daniel S. Warren
- Department of SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Allan B. Massie
- Department of SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins University Bloomberg School of Public HealthBaltimoreMarylandUSA
| | | | - Dorry L. Segev
- Department of SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins University Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - William A. Werbel
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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27
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Massie AB, Werbel WA, Avery RK, Po‐Yu Chiang T, Snyder JJ, Segev DL. Quantifying excess deaths among solid organ transplant recipients in the COVID-19 era. Am J Transplant 2022; 22:2077-2082. [PMID: 35294799 PMCID: PMC9111343 DOI: 10.1111/ajt.17036] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/10/2022] [Accepted: 03/11/2022] [Indexed: 01/25/2023]
Abstract
Estimating the total coronavirus disease 2019 (COVID-19) mortality burden of solid organ transplant recipients (SOTRs), both directly through COVID-19 infection and indirectly through other impacts on the healthcare system and society, is critical for understanding the disease's impact on the SOTR population. Using SRTR data, we modeled expected mortality risk per month pre-COVID (January 2015-February 2020) for kidney/liver/heart/lung SOTRs, and compared monthly COVID-era deaths (March 2020-March 2021) to expected rates, overall and among subgroups. Deaths above expected rates were designated "excess deaths." Between March 2020 and March 2021, there were 3739/827/265/252 excess deaths among kidney/liver/heart/lung SOTRs, respectively, representing a 41.2%/27.4%/18.5%/15.0% increase above expected deaths. 93.0% of excess deaths occurred in patients age≥50. The observed:expected ratio was highest among Hispanic SOTRs (1.82) and lowest among White SOTRs (1.20); 56.0% of excess deaths occurred among Black or Hispanic SOTRs. 64.7% of excess deaths occurred among patients who had survived ≥5 years post-transplant. Excess deaths peaked in January 2021; geographic distribution of excess deaths broadly mirrored COVID-19 incidence. COVID-19 likely caused over 5000 excess deaths among SOTRs in the US in a 13-month period, representing 1 in 75 SOTRs and a substantial proportion of all deaths among SOTRs during this time. SOTRs will remain at elevated mortality risk until the COVID-19 pandemic can be controlled.
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Affiliation(s)
| | - William A. Werbel
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Robin K. Avery
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Teresa Po‐Yu Chiang
- Department of SurgeryJohns Hopkins University School of MedicineBaltimore, MarylandUSA
| | - Jon J. Snyder
- Department of SurgeryJohns Hopkins University School of MedicineBaltimore, MarylandUSA
| | - Dorry L. Segev
- Department of SurgeryJohns Hopkins University School of MedicineBaltimore, MarylandUSA
- Scientific Registry of Transplant RecipientsHennepin Healthcare Research InstituteMinneapolisMinnesotaUSA
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28
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Chang A, Mitchell J, Alejo JL, Chiang TP, Abedon AT, Kim JD, Avery RK, Tobian AAR, Levan ML, Warren DS, Garonzik-Wang JM, Massie AB, Segev DL, Werbel WA. Immunogenicity of Ad26.COV2.S Prime and Two Subsequent Doses of mRNA SARS-CoV-2 Vaccines in Solid Organ Transplant Recipients: A Case Series. Clin Transplant 2022; 36:e14772. [PMID: 35822545 PMCID: PMC9350408 DOI: 10.1111/ctr.14772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 06/30/2022] [Accepted: 07/07/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Amy Chang
- Department of Surgery, Johns Hopkins University School of Medicine
| | | | - Jennifer L Alejo
- Department of Surgery, Johns Hopkins University School of Medicine
| | - Teresa Py Chiang
- Department of Surgery, Johns Hopkins University School of Medicine
| | - Aura T Abedon
- Department of Surgery, Johns Hopkins University School of Medicine
| | - Jake D Kim
- Department of Surgery, Johns Hopkins University School of Medicine
| | - Robin K Avery
- Department of Medicine, Johns Hopkins University School of Medicine
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine
| | - Macey L Levan
- Department of Surgery, New York University Grossman School of Medicine
| | - Daniel S Warren
- Department of Surgery, Johns Hopkins University School of Medicine
| | | | - Allan B Massie
- Department of Surgery, New York University Grossman School of Medicine
| | - Dorry L Segev
- Department of Surgery, New York University Grossman School of Medicine
| | - William A Werbel
- Department of Medicine, Johns Hopkins University School of Medicine
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29
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Chang A, Strauss AT, Alejo JL, Chiang TP, Hernandez NF, Zeiser LB, Boyarsky BJ, Avery RK, Tobian AAR, Levan ML, Warren DS, Garonzik‐Wang JM, Massie AB, Werbel WA, Segev DL. Letter to the editor: Six‐month antibody kinetics and durability in liver transplant recipients after two doses of
SARS‐CoV
‐2
mRNA
vaccination. Hepatol Commun 2022; 6:2990-2992. [PMID: 35791054 PMCID: PMC9350026 DOI: 10.1002/hep4.2027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/09/2022] [Accepted: 05/30/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Amy Chang
- Department of Surgery Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Alexandra T. Strauss
- Department of Medicine Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Jennifer L. Alejo
- Department of Surgery Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Teresa P.‐Y. Chiang
- Department of Surgery Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Nicole F. Hernandez
- Department of Surgery Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Laura B. Zeiser
- Department of Surgery Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Brian J. Boyarsky
- Department of Surgery Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Robin K. Avery
- Department of Medicine Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Aaron A. R. Tobian
- Department of Medicine Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Macey L. Levan
- Department of Surgery Johns Hopkins University School of Medicine Baltimore Maryland USA
- Department of Surgery New York University Grossman School of Medicine New York New York USA
- Department of Population of Health New York University Grossman School of Medicine New York New York USA
| | - Daniel S. Warren
- Department of Surgery Johns Hopkins University School of Medicine Baltimore Maryland USA
| | | | - Allan B. Massie
- Department of Surgery Johns Hopkins University School of Medicine Baltimore Maryland USA
- Department of Surgery New York University Grossman School of Medicine New York New York USA
- Department of Population of Health New York University Grossman School of Medicine New York New York USA
| | - William A. Werbel
- Department of Medicine Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Dorry L. Segev
- Department of Surgery Johns Hopkins University School of Medicine Baltimore Maryland USA
- Department of Surgery New York University Grossman School of Medicine New York New York USA
- Department of Population of Health New York University Grossman School of Medicine New York New York USA
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30
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Mitchell J, Alejo JL, Chiang TP, Kim J, Chang A, Abedon AT, Avery RK, Tobian AA, Massie AB, Levan ML, Warren DS, Garonzik-Wang JM, Segev DL, Werbel WA. Antibody Response to a Fourth Dose of SARS-CoV-2 Vaccine in Solid Organ Transplant Recipients: An Update. Transplantation 2022; 106:e338-e340. [PMID: 35426888 PMCID: PMC9213059 DOI: 10.1097/tp.0000000000004137] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 02/20/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Jonathan Mitchell
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Surgery, Howard University College of Medicine, Washington, DC
| | - Jennifer L. Alejo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Teresa P.Y. Chiang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jake Kim
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Amy Chang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Aura T. Abedon
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Robin K. Avery
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Aaron A.R. Tobian
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Macey L. Levan
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Surgery, NYU Langone Medical Center, New York, NY
| | - Daniel S. Warren
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Surgery, NYU Langone Medical Center, New York, NY
| | - William A. Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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31
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Frey S, Chowdhury R, Connolly CM, Werbel WA, Segev DL, Parian AM. Antibody Response Six Months after SARS-CoV-2 mRNA Vaccination in Patients with Inflammatory Bowel Disease. Clin Gastroenterol Hepatol 2022; 20:1609-1612.e1. [PMID: 34998996 PMCID: PMC8732901 DOI: 10.1016/j.cgh.2021.12.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/22/2021] [Accepted: 12/24/2021] [Indexed: 02/07/2023]
Abstract
Patients with inflammatory bowel disease (IBD) are recommended to receive vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), regardless of their immunosuppression status. Immunosuppressive medications represent a mainstay of therapy in moderate to severe IBD; however, their impact on the SARS-CoV-2 vaccine response remains unclear. Studies thus far have shown that patients with IBD on various therapies had detectable antibody responses after standard vaccinations.1-5 To date, one study has examined the kinetics of antibody response at 3 months after vaccination in patients with IBD, but data beyond this time point are not yet available.6 The aim of this study was to assess anti-spike antibody response 6 months after completion of standard SARS-CoV-2 vaccination in patients with IBD. Secondarily, we observed antibody kinetics over 6 months in a subset of patients post-vaccination.
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Affiliation(s)
- Sarah Frey
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Reezwana Chowdhury
- Division of Gastroenterology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Caoilfhionn M Connolly
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - William A Werbel
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Alyssa M Parian
- Division of Gastroenterology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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32
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Karaba AH, Johnston TS, Aytenfisu TY, Akinde O, Eby Y, Ruff JE, Abedon AT, Alejo JL, Blankson JN, Cox AL, Bailey JR, Klein SL, Pekosz A, Segev DL, Tobian AA, Werbel WA. A Fourth Dose of COVID-19 Vaccine Does Not Induce Neutralization of the Omicron Variant Among Solid Organ Transplant Recipients With Suboptimal Vaccine Response. Transplantation 2022; 106:1440-1444. [PMID: 35417115 PMCID: PMC9213052 DOI: 10.1097/tp.0000000000004140] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Humoral responses to coronavirus disease 2019 (COVID-19) vaccines are attenuated in solid organ transplant recipients (SOTRs), necessitating additional booster vaccinations. The Omicron variant demonstrates substantial immune evasion, and it is unknown whether additional vaccine doses increase neutralizing capacity versus this variant of concern (VOC) among SOTRs. METHODS Within an observational cohort, 25 SOTRs with low seroresponse underwent anti-severe acute respiratory syndrome coronavirus 2 spike and receptor-binding domain immunoglobulin (Ig)G testing using a commercially available multiplex ELISA before and after a fourth COVID-19 vaccine dose (D4). Surrogate neutralization (percent angiotensin-converting enzyme 2 inhibition [%ACE2i], range 0%-100% with >20% correlating with live virus neutralization) was measured against full-length spike proteins of the vaccine strain and 5 VOCs including Delta and Omicron. Changes in IgG level and %ACE2i were compared using the paired Wilcoxon signed-rank test. RESULTS Anti-receptor-binding domain and anti-spike seropositivity increased post-D4 from 56% to 84% and 68% to 88%, respectively. Median (interquartile range) anti-spike antibody significantly increased post-D4 from 42.3 (4.9-134.2) to 228.9 (1115.4-655.8) World Health Organization binding antibody units. %ACE2i (median [interquartile range]) also significantly increased against the vaccine strain (5.8% [0%-16.8%] to 20.6% [5.8%-45.9%]) and the Delta variant (9.1% [4.9%-12.8%] to 17.1% [10.3%-31.7%]), yet neutralization versus Omicron was poor, did not increase post-D4 (4.1% [0%-6.9%] to 0.5% [0%-5.7%]), and was significantly lower than boosted healthy controls. CONCLUSIONS Although a fourth vaccine dose increases anti-spike IgG and neutralizing capacity against many VOCs, some SOTRs may remain at high risk for Omicron infection despite boosting. Thus, additional protective interventions or alternative vaccination strategies should be urgently explored.
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Affiliation(s)
- Andrew H. Karaba
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Trevor S. Johnston
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Olivia Akinde
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yolanda Eby
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jessica E. Ruff
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Aura T. Abedon
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jennifer L. Alejo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joel N. Blankson
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andrea L. Cox
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Bloomberg Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Justin R. Bailey
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sabra L. Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Surgery, NYU Grossman School of Medicine, New York, NY
| | - Aaron A.R. Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - William A. Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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33
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Teles MS, Connolly CM, Wallwork R, Frey S, Chiang TPY, Alejo JL, Albayda J, Christopher-Stine L, Segev DL, Werbel WA, Paik JJ. Safety and immunogenicity of fifth dose SARS-CoV-2 vaccination in patients with autoimmune disease: a case series. Rheumatology (Oxford) 2022; 61:e360-e362. [PMID: 35758603 PMCID: PMC9384401 DOI: 10.1093/rheumatology/keac370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 01/11/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - Dorry L Segev
- Department of Surgery, NYU Grossman School of Medicine, New York, NY,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | | | - Julie J Paik
- Correspondence to: Julie Paik, Division of Rheumatology, Johns Hopkins University, 5501 Hopkins Bayview Circle, Asthma and Allergy Center 1B1, Baltimore, MD 21224, USA. E-mail:
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34
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Werbel WA, Brown DM, Kusemiju OT, Doby BL, Seaman SM, Redd AD, Eby Y, Fernandez RE, Desai NM, Miller J, Bismut GA, Kirby CS, Schmidt HA, Clarke WA, Seisa M, Petropoulos CJ, Quinn TC, Florman SS, Huprikar S, Rana MM, Friedman-Moraco RJ, Mehta AK, Stock PG, Price JC, Stosor V, Mehta SG, Gilbert AJ, Elias N, Morris MI, Mehta SA, Small CB, Haidar G, Malinis M, Husson JS, Pereira MR, Gupta G, Hand J, Kirchner VA, Agarwal A, Aslam S, Blumberg EA, Wolfe CR, Myer K, Wood RP, Neidlinger N, Strell S, Shuck M, Wilkins H, Wadsworth M, Motter JD, Odim J, Segev DL, Durand CM, Tobian AAR. National Landscape of Human Immunodeficiency Virus-Positive Deceased Organ Donors in the United States. Clin Infect Dis 2022; 74:2010-2019. [PMID: 34453519 PMCID: PMC9187316 DOI: 10.1093/cid/ciab743] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Organ transplantation from donors with human immunodeficiency virus (HIV) to recipients with HIV (HIV D+/R+) presents risks of donor-derived infections. Understanding clinical, immunologic, and virologic characteristics of HIV-positive donors is critical for safety. METHODS We performed a prospective study of donors with HIV-positive and HIV false-positive (FP) test results within the HIV Organ Policy Equity (HOPE) Act in Action studies of HIV D+/R+ transplantation (ClinicalTrials.gov NCT02602262, NCT03500315, and NCT03734393). We compared clinical characteristics in HIV-positive versus FP donors. We measured CD4 T cells, HIV viral load (VL), drug resistance mutations (DRMs), coreceptor tropism, and serum antiretroviral therapy (ART) detection, using mass spectrometry in HIV-positive donors. RESULTS Between March 2016 and March 2020, 92 donors (58 HIV positive, 34 FP), representing 98.9% of all US HOPE donors during this period, donated 177 organs (131 kidneys and 46 livers). Each year the number of donors increased. The prevalence of hepatitis B (16% vs 0%), syphilis (16% vs 0%), and cytomegalovirus (CMV; 91% vs 58%) was higher in HIV-positive versus FP donors; the prevalences of hepatitis C viremia were similar (2% vs 6%). Most HIV-positive donors (71%) had a known HIV diagnosis, of whom 90% were prescribed ART and 68% had a VL <400 copies/mL. The median CD4 T-cell count (interquartile range) was 194/µL (77-331/µL), and the median CD4 T-cell percentage was 27.0% (16.8%-36.1%). Major HIV DRMs were detected in 42%, including nonnucleoside reverse-transcriptase inhibitors (33%), integrase strand transfer inhibitors (4%), and multiclass (13%). Serum ART was detected in 46% and matched ART by history. CONCLUSION The use of HIV-positive donor organs is increasing. HIV DRMs are common, yet resistance that would compromise integrase strand transfer inhibitor-based regimens is rare, which is reassuring regarding safety.
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Affiliation(s)
- William A Werbel
- Correspondence: W. A. Werbel, Department of Medicine, Johns Hopkins School of Medicine, 725 N Wolfe St, PCTB/Second Floor, Baltimore, MD 21205 ()
| | - Diane M Brown
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Oyinkansola T Kusemiju
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brianna L Doby
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Shanti M Seaman
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew D Redd
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Yolanda Eby
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Reinaldo E Fernandez
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Niraj M Desai
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jernelle Miller
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gilad A Bismut
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Charles S Kirby
- Department of Biochemistry, Cellular, and Molecular Biology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Haley A Schmidt
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - William A Clarke
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael Seisa
- Laboratory Corporation of America (LabCorp), South San Francisco, California, USA
| | | | - Thomas C Quinn
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Sander S Florman
- Recanati/Miller Transplantation Institute, The Mount Sinai Hospital, New York City, New York, USA
| | - Shirish Huprikar
- Department of Medicine, Division of Infectious Diseases, The Mount Sinai Hospital, New York City, New York, USA
| | - Meenakshi M Rana
- Department of Medicine, Division of Infectious Diseases, The Mount Sinai Hospital, New York City, New York, USA
| | - Rachel J Friedman-Moraco
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, Georgia, USA
| | - Aneesh K Mehta
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, Georgia, USA
| | - Peter G Stock
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Jennifer C Price
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Valentina Stosor
- Division of Infectious Disease and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Shikha G Mehta
- Section of Transplant Nephrology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Alexander J Gilbert
- MedStar Georgetown Transplant Institute, Georgetown University School of Medicine, Washington, DC, USA
| | - Nahel Elias
- Department of Surgery, Division of Transplant Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michele I Morris
- Department of Medicine, Division of Infectious Diseases, University of Miami, Miami, Florida, USA
| | - Sapna A Mehta
- New York University Langone Transplant Institute, New York University Grossman School of Medicine, New York, New York, USA
| | - Catherine B Small
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medical College, New York, New York, USA
| | - Ghady Haidar
- Department of Medicine, Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Maricar Malinis
- Department of Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jennifer S Husson
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Marcus R Pereira
- Department of Medicine, Division of Infectious Diseases, Columbia University Medical Center, New York, New York, USA
| | - Gaurav Gupta
- Department of Medicine, Division of Nephrology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jonathan Hand
- Department of Infectious Diseases, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Varvara A Kirchner
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Avinash Agarwal
- Department of Surgery, Division of Transplantation, University of Virginia, Charlottesville, Virginia, USA
| | - Saima Aslam
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Emily A Blumberg
- Department of Medicine, Division of Infectious Diseases, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cameron R Wolfe
- Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - R Patrick Wood
- Department of Surgery, Division of Transplantation, University of Wisconsin, Madison, Wisconsin, USA
| | - Nikole Neidlinger
- Department of Surgery, Division of Transplantation, University of Wisconsin, Madison, Wisconsin, USA
- UW Health Organ Procurement Organization, Madison, Wisconsin, USA
| | - Sara Strell
- UW Health Organ Procurement Organization, Madison, Wisconsin, USA
| | | | | | | | - Jennifer D Motter
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jonah Odim
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | - HOPE in Action Investigators
PiquantDominqueLinkKatherineRNHemmersbach-MillerMarionMD, PhDPearsonThomasMDTurgeonNicoleMDLyonG MarshallMD, MMScKitchensWilliamMD PhDHuckabyJerylMSCRA, CCRCLasseterA FrancieRNElbeinRivkaRN, BSNRobersonAprilRNFerryElizabethRNKlockEthanBSCochranWilla VCRNPMorrisonMichelleBSNRasmussenSarahBABollingerJuliMSSugarmanJeremyMDSmithAngela RMBAThomasMargaretBSCoakleyMargaretRNTimponeJosephMDStuckeAlyssaBSHaydelBrandyDieterRebeccaPharmDKleinElizabeth JBANeumannHenryMDGallonLorenzoMDGoudyLeahRNCallegariMichelleMarrazzoIliseRN, BSN, MPHJacksonTowandaPruettTimothyMDFarnsworthMaryCCRCLockeJayme EMD, MPH, FACS, FASTMompoint-WilliamsDarnellCRNP, DNPBasingerKatherineRN, CCRPMekeelKristinMDNguyenPhirumBSKwanJoanneSrisengfaTabChin-HongPeterMDRogersRodneySimkinsJacquesMDMunozCarlosCRCDunnTyMDSawinskiDierdreMDSilveiraFernandaMDHughesKaileyMPHPakstisDiana LynnRN, BSN, MBANagyJamieBABaldecchiMaryMuthukumarThangamaniMDEddieMelissa DMS, RNRobbKatharineRNSalsgiverElizabethMPHWittingBrittaBSAzarMarwan MVillanuevaMerceditasFormicaRichardTomlinRicardaBS, CCRP
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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35
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Chang A, Chiang TP, Kim JD, Mitchell J, Alejo JL, Jefferis AA, Avery RK, Tobian AAR, Levan ML, Warren DS, Garonzik-Wang JM, Massie AB, Segev DL, Werbel WA. Improved humoral immunogenicity with mRNA-1273 versus BNT162b2 as third vaccine dose among solid organ transplant recipients seronegative after two BNT162b2 doses. Clin Transplant 2022; 36:e14738. [PMID: 35670813 PMCID: PMC9348091 DOI: 10.1111/ctr.14738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Amy Chang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Teresa Py Chiang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jake D Kim
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jonathan Mitchell
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer L Alejo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alexa A Jefferis
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robin K Avery
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Macey L Levan
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Daniel S Warren
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jacqueline M Garonzik-Wang
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Allan B Massie
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Dorry L Segev
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - William A Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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36
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Connolly CM, Chiang TPY, Teles M, Frey S, Alejo JL, Massie A, Shah AA, Albayda J, Christopher-Stine L, Werbel WA, Segev DL, Paik JJ. Factors associated with poor antibody response to third-dose SARS-CoV-2 vaccination in patients with rheumatic and musculoskeletal diseases. Lancet Rheumatol 2022; 4:e382-e384. [PMID: 35368386 PMCID: PMC8963771 DOI: 10.1016/s2665-9913(22)00065-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Caoilfhionn M Connolly
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Teresa Po-Yu Chiang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Mayan Teles
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Sarah Frey
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Jennifer L Alejo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Allan Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Ami A Shah
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Jemima Albayda
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Lisa Christopher-Stine
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - William A Werbel
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Julie J Paik
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
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37
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Karaba AH, Kim JD, Chiang TPY, Alejo JL, Abedon AT, Mitchell J, Chang A, Eby Y, Johnston TS, Aytenfisu T, Hussey C, Jefferis A, Fortune N, Abedon R, Thomas L, Warren DS, Sitaras I, Pekosz A, Avery RK, Massie AB, Clarke WA, Tobian AA, Segev DL, Werbel WA. Omicron BA.1 and BA.2 Neutralizing Activity Following Pre-Exposure Prophylaxis with Tixagevimab plus Cilgavimab in Vaccinated Solid Organ Transplant Recipients. medRxiv 2022:2022.05.24.22275467. [PMID: 35665017 PMCID: PMC9164440 DOI: 10.1101/2022.05.24.22275467] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Neutralizing antibody responses are attenuated in many solid organ transplant recipients (SOTRs) despite SARS-CoV-2 vaccination. Pre-exposure prophylaxis (PrEP) with the monoclonal antibody combination Tixagevimab and Cilgavimab (T+C) might augment immunoprotection, yet activity against Omicron sublineages in vaccinated SOTRs is unknown. Vaccinated SOTRs who received 300+300mg T+C (either single dose or two 150+150mg doses) within a prospective observational cohort submitted pre- and post-injection samples between 1/10/2022-4/4/2022. Binding antibody (anti-receptor binding domain [RBD], Roche) and surrogate neutralization (%ACE2 inhibition; ≥20% connoting neutralizing inhibition, Meso Scale Discovery) were measured against variants including Omicron sublineages BA.1 and BA.2. Data were analyzed using the Wilcoxon matched-pairs signed-rank test and McNemar's test. Among 61 participants, median (IQR) anti-RBD increased from 424 (IQR <0.8-2322.5) to 3394.5 (IQR 1403.9-7002.5) U/ml post T+C (p<0.001). The proportion demonstrating vaccine strain neutralizing inhibition increased from 46% to 100% post-T+C (p<0.001). BA.1 neutralization was low and did not increase (8% to 16% of participants post-T+C, p=0.06). In contrast, BA.2 neutralization increased from 7% to 72% of participants post-T+C (p<0.001). T+C increased anti-RBD levels, yet BA.1 neutralizing activity was minimal. Encouragingly, BA.2 neutralization was augmented and in the current variant climate T+C PrEP may serve as a useful complement to vaccination in high-risk SOTRs.
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38
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Connolly CM, Frey S, Chiang TPY, Teles M, Alejo JL, Albayda J, Shah AA, Werbel WA, Segev DL, Christopher-Stine L, Paik JJ. Safety of third-dose SARS-CoV-2 vaccination in patients with rheumatic and musculoskeletal disease. Rheumatology (Oxford) 2022; 61:e302-e304. [PMID: 35583259 PMCID: PMC9129174 DOI: 10.1093/rheumatology/keac298] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/05/2022] [Accepted: 05/10/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Caoilfhionn M Connolly
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sarah Frey
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Teresa Po-Yu Chiang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mayan Teles
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jennifer L Alejo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jemima Albayda
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ami A Shah
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - William A Werbel
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L Segev
- Department of Surgery, NYU Grossman School of Medicine, New York, NY
| | - Lisa Christopher-Stine
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Julie J Paik
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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39
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Mitchell J, Connolly CM, Chiang TPY, Alejo JL, Werbel WA, Segev DL, Massie AB. Comparison of SARS-CoV-2 Antibody Response After 2-Dose mRNA-1273 vs BNT162b2 Vaccines in Incrementally Immunosuppressed Patients. JAMA Netw Open 2022; 5:e2211897. [PMID: 35576009 PMCID: PMC9112067 DOI: 10.1001/jamanetworkopen.2022.11897] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
This cohort study compares the antispike antibody titers of the mRNA-1273 and BNT162b2 vaccines for SARS-CoV-2 in incrementally immunosuppressed patients.
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Affiliation(s)
- Jonathan Mitchell
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Caoilfhionn M Connolly
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Teresa Po-Yu Chiang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer L Alejo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - William A Werbel
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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40
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Abedon AT, Alejo JL, Kim JD, Thomas L, Mitchell J, Chiang TPY, Avery RK, Tobian AAR, Levan ML, Warren DS, Massie AB, Garonzik-Wang JM, Segev DL, Werbel WA. Six-month Antibody Kinetics and Durability After 3 Doses of SARS-CoV-2 Vaccine in Solid Organ Transplant Recipients: A Case Series. Transplantation 2022; 106:e281-e283. [PMID: 35066543 PMCID: PMC9038245 DOI: 10.1097/tp.0000000000004069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/29/2021] [Accepted: 12/31/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Aura T. Abedon
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore MD
| | - Jennifer L. Alejo
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore MD
| | - Jake D. Kim
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore MD
| | - Letitia Thomas
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore MD
| | - Jonathan Mitchell
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore MD
| | - Teresa P. Y. Chiang
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore MD
| | - Robin K. Avery
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore MD
| | - Aaron A. R. Tobian
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore MD
| | - Macey L. Levan
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore MD
- Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, MD
| | - Daniel S. Warren
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore MD
| | - Allan B. Massie
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | | | - Dorry L. Segev
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - William A. Werbel
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore MD
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41
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Mitchell J, Chiang TPY, Alejo JL, Chang A, Abedon AT, Avery RK, Tobian AAR, Massie AB, Levan ML, Warren DS, Garonzik-Wang JM, Segev DL, Werbel WA. Effect of Mycophenolate Mofetil Dosing on Antibody Response to SARS-CoV-2 Vaccination in Heart and Lung Transplant Recipients. Transplantation 2022; 106:e269-e270. [PMID: 35250006 PMCID: PMC9038243 DOI: 10.1097/tp.0000000000004090] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/28/2021] [Accepted: 01/11/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Jonathan Mitchell
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Teresa P-Y. Chiang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jennifer L. Alejo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Amy Chang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Aura T. Abedon
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Robin K. Avery
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Aaron A. R. Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Macey L. Levan
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, MD
| | - Daniel S. Warren
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - William A. Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Tsipotis E, Frey S, Connolly C, Werbel WA, Chowdhury R, Dudley-Brown S, Melia JM, Parian AM, Truta B, Yu H, Selaru FM, Segev DL, Lazarev M. Antibody Response 3 Months After 2-Dose SARS-CoV-2 mRNA Vaccination in Patients With Inflammatory Bowel Disease. Am J Gastroenterol 2022; 117:798-801. [PMID: 35103023 DOI: 10.14309/ajg.0000000000001668] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/14/2022] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The response to SARS-CoV-2 vaccination of patients with inflammatory bowel disease (IBD) on immune-modifying therapies requires further investigation because previous studies indicate that patients on immune therapy might have decreased antibody concentrations. METHODS We present the antireceptor binding domain antibody response over a period of 3 months in 217 patients with IBD who completed standard 2-dose SARS-CoV-2 mRNA vaccine series. RESULTS Almost all (98.6%) IBD vaccine recipients had a positive antireceptor binding domain antibody response at least 3 months after vaccination. Decreased antibody titers at 3 months were seen in a subset of patients on antitumor necrosis factor-alpha. Approximately 10% of the participants with high-titer antibodies at 1 month had a decrease to low-positive titers at 3 months, which was mostly observed in those on combination therapy and antitumor necrosis factor-alpha monotherapy. DISCUSSION Larger longitudinal studies are required to define the response in IBD population and its clinical impact.
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Affiliation(s)
- Evangelos Tsipotis
- Hopkins IBD Center, Division of Gastroenterology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sarah Frey
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Caoilfhionn Connolly
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - William A Werbel
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Reezwana Chowdhury
- Hopkins IBD Center, Division of Gastroenterology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sharon Dudley-Brown
- Hopkins IBD Center, Division of Gastroenterology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joanna M Melia
- Hopkins IBD Center, Division of Gastroenterology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alyssa M Parian
- Hopkins IBD Center, Division of Gastroenterology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brindusa Truta
- Hopkins IBD Center, Division of Gastroenterology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Huimin Yu
- Hopkins IBD Center, Division of Gastroenterology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Florin M Selaru
- Hopkins IBD Center, Division of Gastroenterology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mark Lazarev
- Hopkins IBD Center, Division of Gastroenterology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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43
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Strauss AT, Segev DL, Werbel WA. Shared and Data-Driven Decision-Making with Transplant Recipients About COVID-19 Vaccination Is Crucial. Liver Transpl 2022; 28:900-901. [PMID: 35094484 PMCID: PMC9015359 DOI: 10.1002/lt.26418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 01/13/2023]
Affiliation(s)
| | - Dorry L. Segev
- Department of SurgeryJohns Hopkins University School of MedicineBaltimoreMD
- Department of EpidemiologyJohns Hopkins University Bloomberg School of Public HealthBaltimoreMD
| | - William A. Werbel
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
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44
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Abedon AT, Teles MS, Alejo JL, Kim JD, Mitchell J, Chiang TPY, Avery RK, Tobian AAR, Levan ML, Warren DS, Massie AB, Garonzik-Wang JM, Segev DL, Werbel WA. Improved Antibody Response After a Fifth Dose of a SARS-CoV-2 Vaccine in Solid Organ Transplant Recipients: A Case Series. Transplantation 2022; 106:e262-e263. [PMID: 35175241 PMCID: PMC9038246 DOI: 10.1097/tp.0000000000004092] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 01/19/2022] [Accepted: 01/19/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Aura T. Abedon
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mayan S. Teles
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jennifer L. Alejo
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jake D. Kim
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jonathan Mitchell
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Teresa P. Y. Chiang
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Robin K. Avery
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Aaron A. R. Tobian
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Macey L. Levan
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, MD
| | - Daniel S. Warren
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allan B. Massie
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | | | - Dorry L. Segev
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - William A. Werbel
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
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45
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Werbel WA, Segev DL. SARS-CoV-2 antibody testing for transplant recipients: A tool to personalize protection versus COVID-19. Am J Transplant 2022; 22:1316-1320. [PMID: 35119179 PMCID: PMC9111420 DOI: 10.1111/ajt.16993] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 01/25/2023]
Abstract
Anti-spike antibody testing has emerged as a powerful tool to assess SARS-CoV-2 vaccine response in solid organ transplant (SOT) recipients, many of whom remain at risk for COVID-19 despite vaccination. Neither the US Food and Drug Administration nor major transplant societies recommend testing antibody responses after vaccination, or its general incorporation into COVID-19 risk stratification. Notably, in December 2021, the American Society of Transplantation recognized anti-spike seronegativity as a consideration for use of monoclonal antibody pre-exposure prophylaxis. In this viewpoint, we narrate the evolving rationale for anti-spike antibody testing and ultimately recommend that all SOT recipients be tested for anti-spike antibody after vaccination. This result should then be used to personalize efforts to improve protection versus COVID-19 for the most vulnerable, such as additional vaccination strategies and consideration of passive immunoprophylaxis.
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Affiliation(s)
- William A. Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA,Correspondence Dorry Segev, Associate Vice-Chair of Research, Department of Surgery, Johns Hopkins Medical Institutions, 720 Rutland Ave, Ross 34, Baltimore, MD 21205, USA.
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46
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Mitchell J, Kim J, Alejo JL, Chiang TPY, Karaba AH, Blankson JN, Aytenfisu TY, Chang A, Abedon AT, Avery RK, Tobian AA, Massie AB, Levan ML, Warren DS, Garonzik-Wang JM, Segev DL, Werbel WA. Humoral and Cellular Immune Response to a Third Dose of SARS-CoV-2 Vaccine in Kidney Transplant Recipients Taking Belatacept. Transplantation 2022; 106:e264-e265. [PMID: 35289776 PMCID: PMC9038241 DOI: 10.1097/tp.0000000000004100] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Jonathan Mitchell
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Surgery, Howard University College of Medicine, Washington, DC
| | - Jake Kim
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jennifer L. Alejo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Teresa P-Y. Chiang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andrew H. Karaba
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joel N. Blankson
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Amy Chang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Aura T. Abedon
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Robin K. Avery
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Aaron A. Tobian
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Macey L. Levan
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Daniel S. Warren
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - William A. Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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47
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Frey S, Chiang TPY, Connolly CM, Teles M, Alejo JL, Boyarsky BJ, Christopher-Stine L, Werbel WA, Massie AB, Segev DL, Paik JJ. Antibody durability 6 months after two doses of SARS-CoV-2 mRNA vaccines in patients with rheumatic and musculoskeletal disease. The Lancet Rheumatology 2022; 4:e241-e243. [PMID: 35072108 PMCID: PMC8765758 DOI: 10.1016/s2665-9913(21)00417-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sarah Frey
- Department of Surgery, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Teresa Po-Yu Chiang
- Department of Surgery, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Caoilfhionn M Connolly
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Mayan Teles
- Department of Surgery, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Jennifer L Alejo
- Department of Surgery, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Brian J Boyarsky
- Department of Surgery, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Lisa Christopher-Stine
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - William A Werbel
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Allan B Massie
- Department of Surgery, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Dorry L Segev
- Department of Surgery, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Julie J Paik
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
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48
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Karaba AH, Zhu X, Benner SE, Akinde O, Eby Y, Wang KH, Saraf S, Garonzik-Wang JM, Klein SL, Bailey JR, Cox AL, Blankson JN, Durand CM, Segev DL, Werbel WA, Tobian AA. Higher Proinflammatory Cytokines Are Associated With Increased Antibody Titer After a Third Dose of SARS-CoV-2 Vaccine in Solid Organ Transplant Recipients. Transplantation 2022; 106:835-841. [PMID: 35085183 PMCID: PMC8942602 DOI: 10.1097/tp.0000000000004057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Solid organ transplant recipients (SOTRs) are at increased risk for severe COVID-19 and exhibit lower antibody responses to SARS-CoV-2 vaccines. This study aimed to determine if prevaccination cytokine levels are associated with antibody response to SARS-CoV-2 vaccination. METHODS A cross-sectional study was performed among 58 SOTRs before and after two-dose mRNA vaccine series, 35 additional SOTRs before and after a third vaccine dose, and comparison to 16 healthy controls (HCs). Antispike antibody was assessed using the IgG Euroimmun ELISA. Electrochemiluminescence detection-based multiplexed sandwich immunoassays (Meso Scale Diagnostics) were used to quantify plasma cytokine and chemokine concentrations (n = 20 analytes) and compare concentrations between SOTRs and HCs, stratified by ultimate antibody response to the vaccine using Wilcoxon-rank-sum test with false discovery rates computed to correct for multiple comparisons. RESULTS In the study population, 100% of HCs, 59% of SOTRs after 2 doses and 63% of SOTRs after 3 doses had a detectable antibody response. Multiple baseline cytokines were elevated in SOTRs versus HCs. There was no significant difference in baseline cytokine levels between SOTRs with high versus low-titer antibodies after 2 doses of vaccine. However, as compared with poor antibody responders, SOTRs who went on to develop a high-titer antibody response to a third dose of vaccine had significantly higher prethird dose levels of several innate immune cytokines including IL-17, IL-2Ra, IL-6, IP-10, MIP-1α, and TNF-α (false discovery rates < 0.05). CONCLUSIONS A specific inflammatory profile may be associated with developing higher antibodies in response to a third dose of SARS-CoV-2 vaccine in SOTRs.
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Affiliation(s)
- Andrew H. Karaba
- Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Xianming Zhu
- Department of Pathology, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Sarah E. Benner
- Department of Pathology, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Olivia Akinde
- Department of Pathology, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Yolanda Eby
- Department of Pathology, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Kristy H. Wang
- Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Sharada Saraf
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, MD
| | | | - Sabra L. Klein
- Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Justin R. Bailey
- Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Andrea L. Cox
- Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
- Bloomberg Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Joel N. Blankson
- Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Christine M. Durand
- Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD
| | - William A. Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Aaron A.R. Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD
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49
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Karaba AH, Zhu X, Liang T, Wang KH, Rittenhouse AG, Akinde O, Eby Y, Ruff JE, Blankson JN, Abedon AT, Alejo JL, Cox AL, Bailey JR, Thompson EA, Klein SL, Warren DS, Garonzik-Wang JM, Boyarsky BJ, Sitaras I, Pekosz A, Segev DL, Tobian AA, Werbel WA. A third dose of SARS-CoV-2 vaccine increases neutralizing antibodies against variants of concern in solid organ transplant recipients. Am J Transplant 2022; 22:1253-1260. [PMID: 34951746 PMCID: PMC8983554 DOI: 10.1111/ajt.16933] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/30/2021] [Accepted: 12/18/2021] [Indexed: 01/25/2023]
Abstract
Vaccine-induced SARS-CoV-2 antibody responses are attenuated in solid organ transplant recipients (SOTRs) and breakthrough infections are more common. Additional SARS-CoV-2 vaccine doses increase anti-spike IgG in some SOTRs, but it is uncertain whether neutralization of variants of concern (VOCs) is enhanced. We tested 47 SOTRs for clinical and research anti-spike IgG, pseudoneutralization (ACE2 blocking), and live-virus neutralization (nAb) against VOCs before and after a third SARS-CoV-2 vaccine dose (70% mRNA, 30% Ad26.COV2.S) with comparison to 15 healthy controls after two mRNA vaccine doses. We used correlation analysis to compare anti-spike IgG assays and focused on thresholds associated with neutralization. A third SARS-CoV-2 vaccine dose increased median total anti-spike (1.6-fold), pseudoneutralization against VOCs (2.5-fold vs. Delta), and neutralizing antibodies (1.4-fold against Delta). However, neutralization activity was significantly lower than healthy controls (p < .001); 32% of SOTRs had zero detectable nAb against Delta after third vaccination compared to 100% for controls. Correlation with nAb was seen at anti-spike IgG >4 Log10 (AU/ml) on the Euroimmun ELISA and >4 Log10 (AU/ml) on the MSD research assay. These findings highlight benefits of a third vaccine dose for some SOTRs and the need for alternative strategies to improve protection in a significant subset of this population.
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Affiliation(s)
- Andrew H. Karaba
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xianming Zhu
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tao Liang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kristy H. Wang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alex G. Rittenhouse
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Olivia Akinde
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yolanda Eby
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jessica E. Ruff
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joel N. Blankson
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aura T. Abedon
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer L. Alejo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrea L. Cox
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Bloomberg Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Justin R. Bailey
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elizabeth A. Thompson
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Bloomberg Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sabra L. Klein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Daniel S. Warren
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Brian J. Boyarsky
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ioannis Sitaras
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Andrew Pekosz
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aaron A.R. Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - William A. Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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50
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Durand CM, Florman S, Motter JD, Brown D, Ostrander D, Yu S, Liang T, Werbel WA, Cameron A, Ottmann S, Hamilton JP, Redd AD, Bowring MG, Eby Y, Fernandez RE, Doby B, Labo N, Whitby D, Miley W, Friedman-Moraco R, Turgeon N, Price JC, Chin-Hong P, Stock P, Stosor V, Kirchner V, Pruett T, Wojciechowski D, Elias N, Wolfe C, Quinn TC, Odim J, Morsheimer M, Mehta SA, Rana MM, Huprikar S, Massie A, Tobian AA, Segev DL. HOPE in action: A prospective multicenter pilot study of liver transplantation from donors with HIV to recipients with HIV. Am J Transplant 2022; 22:853-864. [PMID: 34741800 PMCID: PMC9997133 DOI: 10.1111/ajt.16886] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 01/25/2023]
Abstract
Liver transplantation (LT) from donors-with-HIV to recipients-with-HIV (HIV D+/R+) is permitted under the HOPE Act. There are only three international single-case reports of HIV D+/R+ LT, each with limited follow-up. We performed a prospective multicenter pilot study comparing HIV D+/R+ to donors-without-HIV to recipients-with-HIV (HIV D-/R+) LT. We quantified patient survival, graft survival, rejection, serious adverse events (SAEs), human immunodeficiency virus (HIV) breakthrough, infections, and malignancies, using Cox and negative binomial regression with inverse probability of treatment weighting. Between March 2016-July 2019, there were 45 LTs (8 simultaneous liver-kidney) at 9 centers: 24 HIV D+/R+, 21 HIV D-/R+ (10 D- were false-positive). The median follow-up time was 23 months. Median recipient CD4 was 287 cells/µL with 100% on antiretroviral therapy; 56% were hepatitis C virus (HCV)-seropositive, 13% HCV-viremic. Weighted 1-year survival was 83.3% versus 100.0% in D+ versus D- groups (p = .04). There were no differences in one-year graft survival (96.0% vs. 100.0%), rejection (10.8% vs. 18.2%), HIV breakthrough (8% vs. 10%), or SAEs (all p > .05). HIV D+/R+ had more opportunistic infections, infectious hospitalizations, and cancer. In this multicenter pilot study of HIV D+/R+ LT, patient and graft survival were better than historical cohorts, however, a potential increase in infections and cancer merits further investigation.
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Affiliation(s)
- Christine M. Durand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sander Florman
- Recanati-Miller Transplantation Institute, The Mount Sinai Hospital, New York, NY
| | - Jennifer D. Motter
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Diane Brown
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Darin Ostrander
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sile Yu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Tao Liang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - William A. Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andrew Cameron
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shane Ottmann
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - James P. Hamilton
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andrew D. Redd
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Mary G. Bowring
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yolanda Eby
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Nazzarena Labo
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, Maryland, United States of America
| | - Denise Whitby
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, Maryland, United States of America
| | - Wendell Miley
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, Maryland, United States of America
| | | | | | - Jennifer C. Price
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Peter Chin-Hong
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Peter Stock
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Valentina Stosor
- Divisions of Infectious Diseases and Organ Transplantation Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | | | - Cameron Wolfe
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC
| | - Thomas C. Quinn
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Jonah Odim
- Division of Allergy, Immunology and Transplantation, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Megan Morsheimer
- Division of Allergy, Immunology and Transplantation, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Sapna A. Mehta
- New York University Langone Transplant Institute, New York, NY
| | - Meenakshi M. Rana
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York NY
| | - Shirish Huprikar
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York NY
| | - Allan Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Aaron A.R. Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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