Antibody Response to Severe Acute Respiratory Syndrome‐Coronavirus‐2 Messenger RNA Vaccines in Liver Transplant Recipients

Abstract

Prior studies have demonstrated a decreased humoral response in solid organ transplant recipients (SOTRs) to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) messenger RNA (mRNA) vaccination (17% antibody response after dose 1 [D1], 54% after dose 2 [D2]) compared with the general population (100%).However, these studies were dominated by kidney transplant recipients and included only a small percentage of liver transplantation (LT) recipients (19.6%). (1)(2)(3)(4) Because LT recipients often receive milder induction and maintenance immunosuppression, they may have a more robust humoral response. To investigate this, we studied SARS-CoV-2 antibody development in a cohort of LT recipients who completed a 2-dose mRNA vaccine series of either mRNA-1273 (Moderna, Cambridge, MA) or BNT162b2 (Pfizer-BioNTech, New York, NY). Patients and MethodsInclusion criteria were post-LT patients with no reported prior positive SARS-CoV-2 polymerase chain reaction result. Participants were excluded if they were younger than 18 years old. Participants were recruited via convenience sampling through social media or transplant center advertisements and if they completed a 2-dose mRNA vaccine course between January 7, 2021, and March 26, 2021 and were followed through April 7, 2021. Data on demographics, body mass index (BMI), prior COVID-19 diagnosis, hospitalization, transplant information, medications, other immune conditions, and allergies were collected. The study had institutional review board approval, and informed consent was obtained. The blood sampling protocol used 2 SARS-CoV-2 spike protein immunoassays (EUROIMMUN [Lubek, Germany] to the subunit 1 [S1] domain and Roche Elecsys [Indianapolis, IN] to the receptor binding domain [RBD] of the SARS-CoV-2 spike protein) and has been described elsewhere. (1) We have shown in prior work that the distribution of vaccine responses did not differ when using the anti-S1 or anti-RBD assay. (4) The post-D1 assay was performed as close to D2 as possible, and the post-D2 assay was collected as close to 28 days as possible. Of note, the Roche assay is artificially truncated at >250 U/mL.

Immunological and clinical efficacy of COVID-19 vaccines in immunocompromised populations: a systematic review

“…Forty-seven studies described immunogenicity across various solid organ transplant populations ( n = 5974), mostly in kidney transplant recipients ( n = 3534, 59.2%) ( Table S5 ) [ 18 , [20] , [21] , [22] , [23] , [24] , [25] , [26] , 29 , 34 , 40 , [56] , [57] , [58] ], [ 62 , 63 , 65 , 66 , 69 , 72 , 73 , 75 , 77 , 79 , 81 , 120 , 126 ], [ [136] , [137] , [138] , [139] , [140] , [141] , [142] , [143] , [144] , [145] , [146] , [147] , [148] , [149] , [150] , [151] , [152] , [153] , [154] , [155] , [156] , [157] , [158] , [159] , [160] ]. Twenty-four of those studies included a control group representing overall 1399 participants [ 21 , 34 , 57 , 63 , 66 , 69 , 72 , 73 , 75 , 79 , ...…”

“…Solid organ transplant-specific treatments (calcineurin inhibitors, antimetabolites, corticosteroids) were often associated with a higher non-response rate or lower antibody titres [ 20 , 21 , 24 , 40 , 56 , 62 , 65 , 69 , 72 , 75 , 81 , 136 , [138] , [139] , [140] , [141] , [142] , 144 , 145 , 148 , [154] , [155] , [156] , [157] , 159 , 160 ] ( Table S5 ). Older age and lower estimated glomerular filtration rate were repeatedly associated with a non-responder status [ 21 , 24 , 79 , 120 , 138 , 142 , 144 , 155 ].…”

“…Immunogenicity varied across vaccine type: the Pfizer [ 21 , 38 , 39 , 103 , 130 , 159 ] and Janssen vaccines [ 38 , 39 ] were repeatedly associated with non-response status or lower antibody titres compared than the Moderna vaccine. Two studies found higher odds of non-response when vaccinated with the Janssen vaccine compared with the two mRNA vaccines [ 27 , 40 ].…”

Vaccination in Chronic Liver Disease: An Update

“…Studies in solid organ transplant recipients that analyzed immunogenicity following 2 doses of COVID-19 mRNA vaccines have demonstrated suboptimal humoral immune response 47 . However, few studies that looked at vaccine efficacy exclusively in LT recipients have shown mixed results 48 , 49 , 50 . One study involving 161 LT recipients (53% received Pfizer and 47% received Moderna) reported a robust immune with 81% of participants producing detectable antibodies 30 days after the second shot 48 .…”

COVID‐19 and digestive health: Implications for prevention, care and the use of COVID‐19 vaccines in vulnerable patients

“… 30 Antibody‐responses ranged between 47.5% 28 and 81%. 31 The efficacy of a third dose of COVID‐19 vaccine has been evaluated in two studies. In a study with 30 patients with suboptimal response, a third dose increased antibody titers in one third of patients who had negative antibody titers and in all patients who had low‐positive antibody titers.…”