Evaluation of the Kinetics of Antibody Response to COVID-19 Vaccine in Solid Organ Transplant Recipients: The Prospective Multicenter ORCHESTRA Cohort

Abstract

Previous studies assessing the antibody response (AbR) to mRNA COVID-19 vaccines in solid organ transplant (SOT) recipients are limited by short follow-up, hampering the analysis of AbR kinetics. We present the ORCHESTRA SOT recipients cohort assessed for AbR at first dose (t0), second dose (t1), and within 3 ± 1 month (t2) after the first dose. We analyzed 1062 SOT patients (kidney, 63.7%; liver, 17.4%; heart, 16.7%; and lung, 2.5%) and 5045 health care workers (HCWs). The AbR rates in the SOTs and HCWs were 52.3% and 99.4%. The antibody levels were significantly higher in the HCWs than in the SOTs (p < 0.001). The kinetics showed an increase (p < 0.001) in antibody levels up to 76 days and a non-significant decrease after 118 days in the SOT recipients versus a decrease up to 76 days (p = 0.02) and a less pronounced decrease between 76 and 118 days (p = 0.04) in the HCWs. Upon multivariable analysis, liver transplant, ≥3 years from SOT, mRNA-1273, azathioprine, and longer time from t0 were associated with a positive AbR at t2. Older age, other comorbidities, mycophenolate, steroids, and impaired graft function were associated with lower AbR probability. Our results may be useful to optimize strategies of immune monitoring after COVID-19 vaccination and indications regarding timing for booster dosages calibrated on SOT patients’ characteristics.

Humoral and T-cell response 12 months after the first BNT162b2 vaccination in solid organ transplant recipients and controls: Kinetics, associated factors, and role of SARS-CoV-2 infection

“…However, females are known to have more robust immune responses to antigens due to the effects of sex hormones and X-linked genes (66,67), and we cannot exclude that our finding is due to confounding factors that we have not accounted for. Kidney or lung transplant recipients were associated with the humoral non response but not with the T-cell non response, which corroborates well with previous reports (10,18,34,68,69). In our study, kidney transplant recipients had the highest proportion of cardiovascular diseases, and lung transplant recipients more commonly received CNI/mTOR inhibitors and corticosteroids, which could partly explain the differences in the immune response.…”

Determinants of anti-S immune response at 6 months after COVID-19 vaccination in a multicentric European cohort of healthcare workers – ORCHESTRA project

“…Carlotta Zunarelli (1), Roberta Bonfiglioli (1), Angela Carta (2), Giuseppe Verlato (12), Giuseppe Lippi (13), Davide Gibellini (14), Maria Diletta Pezzani (15), Lorena Torroni (12), Michael Hoelscher (5), Andreas Wieser (5), Christina Reinkemeyer (5), Michael Plank (5), Ivan Noreña (5), Raquel Rubio-Acero (5), Simon Winter (5), Mihaela Leustean (7), Ovidiu Perseca (7), Madalina Ipate (7), Agripina, Rascu (16), Jozef Strhaŕsky (17), Petra Hellebrandt (18), Daniela Krizǎnová (19), Marianna Mraźová(20), Luigi De Maria (10), Stefania Sponselli (10), Pasquale Stefanizzi (10), Antonio Caputi (10). 12 Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy, 13 Section of Clinical Biochemistry, University of Verona, Verona, Italy, 14 Section of Microbiology, University of Verona, Verona, Italy, 15 Infectious Disease Unit, University Hospital of Verona, Verona, Italy, 16…”

“…This analysis within ORCHESTRA is focused on the characteristics of anti-Sars-CoV-2 Spike immune response to COVID-19 vaccines at 6 months since the 1rst dose. Previous publications based on ORCHESTA dataset reported the kinetics of antibody response to COVID-19 vaccination ( 19 ), the predictors of immunological response to vaccination ( 20 ), as well as the predictors of COVID-19 infection in HCWs by occupational factors such as use of personal protective equipment (PPE) and job title ( 12 ).…”

Seroconversion following a booster dose of COVID-19 vaccine in liver transplant recipients. A systematic review and meta-analysis

“…However, patients receiving immunosuppressive regimens were excluded from the initial licensing clinical trials of COVID-19 vaccines. In addition, accumulative data have shown lower immunogenic response in SOT recipients, compared to the general population [5][6][7], attributable mainly to the use of immunosuppression. A recent systematic review/meta-analysis of 29 studies and 11,713 recipients of SOT, documented reduced seroconversion rates after two doses of COVID-19 vaccine [44.9% (0%-79.1%) seroconversion rate for antispike antibodies and 22.6% (0%-47.5%) for neutralizing antibodies] [8].…”

“…In this metaanalysis [12] no separate data for LTRs were provided since the included studies were not focused on LTRs. However, heterogeneity in seroconversion rates among SOT recipients after COVID-19 vaccination, depending on the type of transplant organ, is well established [6], indicating the need for studies reporting data separately for each organ recipient group. In fact, only recently, studies including solely LTRs have been published regarding the immunogenicity and tolerability after a booster dose of COVID-19 vaccine in the LT setting.…”