Immunogenicity and Risk Factors Associated With Poor Humoral Immune Response of SARS-CoV-2 Vaccines in Recipients of Solid Organ Transplant

Abstract

Key Points Question What are the humoral immune response rates and risk factors associated with diminished response after COVID-19 vaccination in recipients of solid organ transplant? Findings In this systematic review and meta-analysis of 29 studies and 11 713 recipients of solid organ transplant, seroconversion rates increased with progressively increased numbers of mRNA COVID-19 vaccine doses. Older age, recent transplantation, deceased donor status, active use of antimetabolites, and recent exposure to antithymocyte globulin or rituximab were risk factors associated with diminished humoral immune response after receiving 2 doses of mRNA vaccines. Meaning These findings suggest that more efforts are needed to modulate the risk factors associated with reduced humoral responses among recipients of solid organ transplant.

Vaccination for the Prevention of Infection among Immunocompromised Patients: A Concise Review of Recent Systematic Reviews

“…In general, the studies showed that patients with chronic kidney failure on dialysis (not requiring organ transplantation) [ 10 , 11 , 12 ], immune-mediated inflammatory diseases [ 13 , 14 , 15 , 16 ], and solid tumors [ 17 ] had seroconversion rates that were high and similar to healthy controls (seroconversion rates among patients ranged from about 83% to 97%). In contrast, patients with receipt of anti-CD20 therapy [ 18 ] and solid organ transplants [ 11 , 19 , 20 ] (thus requiring anti-rejection immunosuppression) had markedly low vaccine seroconversion rates (rates ranged from about 26% to 45% after two vaccine doses). Patients with hematologic cancers had intermediate seroconversion rates (rates ranged from about 54% to 65%) [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ].…”

“…Patients with hematologic cancers had intermediate seroconversion rates (rates ranged from about 54% to 65%) [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. An intervention that improved vaccine efficacy was the use of additional booster vaccine doses [ 20 ].…”

“…For the poor vaccine response category, given possible vaccine nonresponse, seroconversion may be checked. If nonresponse is demonstrated, additional booster doses may be considered [ 11 , 20 , 65 ]. Alternatively, long-acting monoclonal antibodies for pre-exposure prophylaxis may be considered in patients at high risk of acquiring serious infection [ 66 ].…”

Tolerability and Reactogenicity Profile of mRNA SARS-Cov-2 Vaccines from a Mass Vaccination Campaign in a Tertiary Hospital: Between-Vaccine and Between-Population Prospective Observational Study (VigilVacCOVID Study)

“…The primary objective was to make a comparative present less robust immune responses than nontransplant patients [13]. Studies have found a reduced humoral immune response to BNT162b2 and mRNA-1273 mRNA vaccines in SOTRs after the first and second doses, measured by antispike antibody responses [14,15] in kidney [16], lung [17], heart [18,19], liver [20], and in general in SOTRs [15], who are underrepresented in clinical trials. However, many immunosuppressed patients and patients with other comorbidities have already been vaccinated with up to four doses in many countries, and few prospective studies have been specifically designed to target these patients.…”

Remdesivir resistance in transplant recipients with persistent COVID-19

“…While measures to curb the spread of SARS-CoV-2, a pathogen that has claimed the lives of more than a million Americans, continue to ease in many parts of the United States, the risk of adverse outcomes related to infection in immunocompromised hosts remains substantial 1,2 . In a recent meta-analysis that included nearly 12,000 solid organ transplant (SOT) recipients, vaccination against COVID-19 elicited a humoral response that was signi cantly reduced compared to that of immunocompetent hosts 3 . Though vaccination results in a markedly decreased risk of severe infection in the immunocompetent majority, a diminished response to vaccination translates to a greater risk of severe disease and death in SOT recipients 4 .…”