Severe COVID-19 by SARS-CoV-2 Lineage B.1.1.7 in Vaccinated Solid-Organ Transplant Recipients: New Preventive Strategies Needed to Protect Immunocompromised Patients

Abstract

Background: Solid-organ transplant (SOT) recipients are at a high risk of severe COVID-19, and are priority for vaccination. Here, we describe three cases of severe COVID-19 caused by SARS-CoV-2 B.1.1.7 lineage in vaccinated SOT recipients. Methods: Three SOT patients were hospitalized in the Policlinico Hospital of Bari (southern Italy) and underwent nasopharyngeal swabs for molecular detection of SARS-CoV-2 genes and spike protein mutations by real-time PCR. One sample was subjected to whole-genome sequencing. Results: One patient was a heart transplant recipient and two were kidney transplant recipients. All were hospitalized with severe COVID-19 between March and May 2021. Two patients were fully vaccinated and one had received only one dose of the BNT162b2 mRNA vaccine. All the patients showed a high viral load at diagnosis, and molecular typing revealed the presence of B.1.1.7 lineage SARS-CoV-2. In all three cases, prolonged viral shedding was reported. Conclusions: The three cases pose concern about the role of the B.1.1.7 lineage in severe COVID-19 and about the efficacy of COVID-19 vaccination in immunocompromised patients. Protecting immunocompromised patients from COVID-19 is a challenge. SOT recipients show a suboptimal response to standard vaccination, and thus, an additive booster or a combined vaccination strategy with mRNA, protein/subunit, and vector-based vaccines may be necessary. This population should continue to practice strict COVID-19 precautions post-vaccination, until new strategies for protection are available.

Immune Response to SARS-CoV-2 Vaccine among Heart Transplant Recipients: A Systematic Review

“…The full text of 18 studies was further evaluated for eligibility. Of these, 12 articles were eligible to be included into this systematic review [17][18][19][20][21][24][25][26][27][28][29][30] (Figure 1). This encompassed a total of 563 HTX recipients with an average age of 60.8 years (range: 18-80), who received at least 1 dose of SARS-CoV-2 vaccine.…”

“…This encompassed a total of 563 HTX recipients with an average age of 60.8 years (range: 18-80), who received at least 1 dose of SARS-CoV-2 vaccine. Out of the studies with a reported gender distribution (496 patients), [17][18][19][20][24][25][26][27][28]30 319 were male (64.3%) and 177 were female (35.7%). The patient population enrolled in these studies were from Israel, 24,[26][27][28] Europe (Italy, Spain, Germany, and Greece), 17,[19][20][21]29 Taiwan, 30 and the USA 18,25 (Table 1).…”

“…[12][13][14] However, due to chronic immunosuppression and existence of multiple comorbidities, production of sufficient anti-SARS-CoV-2 spike immunoglobulin titer or effective neutralizing antibody after vaccination against COVID-19 has been variable among patients with a transplanted solid organ. [15][16][17][18][19][20][21] As HTX patients constitute a unique population of transplant recipients, we aimed to conduct this systematic review to summarize scarce data in the literature on the development of immune response following vaccination against SARS-CoV-2 and factors associated with a weaker immunity.…”

Immunosuppression and SARS-CoV-2 Infection in Kidney Transplant Recipients

“…10 Case series of severe SARS-CoV-2 infections in fully vaccinated KTRs have been reported. 95,96 A recent large multicenter study showed that compared with 101 million fully vaccinated adults in the United States, fully vaccinated SOT recipients (n = 18.215) had an 82-fold higher risk of breakthrough infection and 485-fold higher risk of breakthrough infection with associated hospitalization and death. 97 These data emphasize the importance of the adaptative immune response in the defense against the virus.…”

Tacrolimus-resistant SARS-CoV-2-specific T cell products to prevent and treat severe COVID-19 in immunosuppressed patients

“…[15][16][17][18][19][20] Indeed, initial studies reported that, despite being vaccinated, SOT patients still became infected with SARS-CoV-2 and required hospitalization, highlighting the necessity of novel strategies to protect this vulnerable population. [21][22][23] SARS-CoV-2-specific T cells have been detected in convalescent patients in multiple studies, indicating an important role for T cells in viral clearance and development of protective immunity. [24][25][26] Thus, SARS-CoV2-specific adoptive T cell therapy (ACT) has been suggested as an early treatment or preventive strategy for COVID-19 in immunocompromised or immunosuppressed individuals 27 as well as more generally for treatment of acute COVID-19.…”