Question addressed by the studyDo three COVID-19 vaccine doses induce a serological response in lung transplant recipients?Patients and MethodsWe retrospectively included 1071 adults (551 [52%] males) at nine transplant centres in France. Each had received three COVID-19 vaccine doses in 2021, after lung transplantation. An anti-spike protein IgG response, defined as a titre >264 BAU·mL−1after (median, 3.0 [1.7–4.1] months) the third dose was the primary outcome, and adverse events were the secondary outcomes. Median age at the first vaccine dose was 54 [40–63] years and median time from transplantation to the first dose was 64 [30–110] months.ResultsMedian follow-up after the first dose was 8.3 [6.7–9.3] months. A vaccine response developed in 173 (16%) patients. Factors independently associated with a response were younger age at vaccination, longer time from transplantation to vaccination, and absence of corticosteroid or mycophenolate therapy. After vaccination, 51 (5%) patients (47 non-responders [47/898, 5%] and 4 [4/173, 2%] responders) experienced COVID-19, at a median of 6.6 [5.1–7.3] months after the third dose. No responders had severe COVID-19, compared to 15 non-responders, including six who died of the disease.Answer to the questionFew lung transplant recipients achieved a serological response to three COVID-19 vaccine doses, indicating a need for other protective measures. Older age and use of mycophenolate or corticosteroids were associated with absence of a response. The low incidence of COVID-19 might reflect vaccine protectionviacellular immunity and/or good adherence to shielding measures.

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