mRNA Vaccine Effectiveness Against Coronavirus Disease 2019 Hospitalization Among Solid Organ Transplant Recipients

Abstract

Background The study objective was to evaluate 2 and 3 dose COVID-19 mRNA vaccine effectiveness (VE) in preventing COVID-19 hospitalization among adult solid organ transplant (SOT) recipients. Methods 21-site case-control analysis of 10,425 adults hospitalized March-December 2021. Cases were hospitalized with COVID-19; controls were hospitalized for an alternative diagnosis (SARS-CoV-2 negative). Participants were classified as: SOT recipient (n=440), other immunocompromising condition (n=1684), or immunocompetent (n=8301). VE against COVID-19 associated hospitalization was calculated as 1–adjusted odds ratio of prior vaccination among cases compared with controls. Results Among SOT recipients, VE was 29% (95% CI: -19 to 58%) for 2 doses and 77% (95% CI: 48 to 90%) for 3 doses. Among patients with other immunocompromising conditions, VE was 72% (95% CI: 64 to 79%) for 2 doses and 92% (95% CI: 85 to 95%) for 3 doses. Among immunocompetent patients, VE was 88% (95% CI: 87 to 90%) for 2 doses and 96% (95% CI: 83 to 99%) for 3 doses. Conclusion Effectiveness of COVID-19 mRNA vaccines was lower for SOT recipients than immunocompetent people and those with other immunocompromising conditions. Among SOT recipients, vaccination with 3 doses of an mRNA vaccine led to substantially greater protection than 2 doses.

Impact of COVID-19 on the liver and on the care of patients with chronic liver disease, hepatobiliary cancer, and liver transplantation: An updated EASL position paper

“…For example, data from a North American cohort of patients with cirrhosis did show that infection after one or two mRNA vaccines was associated with reduced mortality compared to COVID-19 in unvaccinated individuals [ 254 ]. In a large case-control study including 440 SOT recipients, vaccine effectiveness in preventing COVID-19 hospitalizations was lower compared with immunocompetent individuals, although protection was significantly improved with three compared to two mRNA vaccine doses [ 289 ].…”

Immune responses following 3rd and 4th doses of heterologous and homologous COVID-19 vaccines in kidney transplant recipients

“…Consistent with this immunogenicity data, real world vaccine efficacy has been shown to be inferior in immunocompromised people, who have been at highest risk of breakthrough infections and severe disease, in the pre-Omicron era [12][13][14] . So, what does this mean for the strategic forward planning to protect transplant recipients?…”

Response to Correspondence on Outcomes of COVID-19 in Unvaccinated Compared With Vaccinated Solid Organ Transplant Recipients

“…Our results are further supported by (a) poor immunogenicity of 2 compared with 3 vaccine doses 3 ; (b) greater disease severity with 1 or 2 than with 3 or more vaccine doses during the Omicron wave 4 ; and (c) significantly lower vaccine effectiveness with 2 versus 3 vaccine doses. 5 Thus, the main conclusions of the study are made in this context.…”