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Liu S, van Dijk LLA, den Hartog Y, Hoek R, Verschuuren E, Geurtsvankessel CH, de Vries RD, Van Baarle D, Buter CVL. mRNA-based COVID-19 vaccination of lung transplant recipients with prior SARS-CoV-2 infection induces durable SARS-CoV-2-specific antibodies and T cells. Vaccine 2024; 42:126250. [PMID: 39226789 DOI: 10.1016/j.vaccine.2024.126250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 08/15/2024] [Accepted: 08/17/2024] [Indexed: 09/05/2024]
Abstract
Lung transplant recipients (LTRs) are particularly at risk of developing severe coronavirus disease-2019 (COVID-19), but are also difficult to protect by vaccination due to their immunocompromised state. Here, we investigated the immunogenicity of mRNA-based COVID-19 vaccines in LTRs who had a prior natural SARS-CoV-2 infection. At a median of 184 days after SARS-CoV-2 infection, LTRs were vaccinated twice with the mRNA-1273 COVID-19 vaccine, with a 28-day interval. Blood samples were obtained pre-vaccination, 28 days after the first dose, and 28 days and 6 months after the second dose. Spike (S-) and nucleocapsid (N-) specific antibodies were measured, as well as neutralization of the ancestral and Omicron BA.5 variant. S-specific T cell responses were evaluated using IFN-γ ELISpot,IGRA, and activation markers by flow cytometry. Phenotyping of T cells was performed by using high-resolution spectral flow cytometry. Most LTRs with prior infection had detectable S-specific antibodies and T cells at baseline. After the first vaccination, S-specific antibody levels increased significantly; an additional increase was observed after the second vaccination. N-specific antibodies decreased during the study period, indicative of the fact that no further breakthrough infections occurred. An increase in IFN-γ producing T cells was observed after the first vaccination, but no additional boost could be detected after the second vaccination. Antibody levels and virus-specific T cell responses remained significantly higher compared to pre-vaccination levels at 6 months post-vaccination, indicating an additive and durable effect of vaccination after infection in LTRs. Neutralizing antibodies were detected against the ancestral strain and retained cross-reactivity with Omicron BA.5, albeit at lower levels. Moreover, the quantity and phenotype of SARS-CoV-2 spike-specific T cells were similar in LTRs compared to controls with hybrid immunity. In conclusion, mRNA-based COVID-19 vaccines are immunogenic in LTRs with prior immunity, and antibody and T cell responses are durable up to 6 months post-vaccination.
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Affiliation(s)
- Siqi Liu
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, the Netherlands.
| | - Laura L A van Dijk
- Department of Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Yvette den Hartog
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC Transplant Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Rogier Hoek
- Department of Pulmonary Medicine, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Erik Verschuuren
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Rory D de Vries
- Department of Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Debbie Van Baarle
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, the Netherlands; Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
| | - Coretta Van Leer Buter
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, the Netherlands
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Cona A, Tavelli A, Agrenzano S, Hafeez N, Scianna G, Maria A, Marino F, Cruz EDL, Giorgio MD, Osorio E, Cucinella G, Luca A, Provenzani A, Vitulo P, Bertani A, Grossi PA, Mularoni A. Tixagevimab/Cilgavimab as SARS-CoV-2 Pre-Exposure Prophylaxis in Lung Transplant Recipients during the Omicron Wave: A Real-World Monocentric Experience. Microorganisms 2024; 12:1436. [PMID: 39065204 PMCID: PMC11279136 DOI: 10.3390/microorganisms12071436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 06/29/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
Lung transplant recipients (LTRs) respond poorly to vaccination. SARS-CoV-2 pre-exposure prophylaxis (PrEP) with tixagevimab/cilgavimab (TIX/CIL) reduces the incidence of infection and the evolution to severe COVID-19. In vitro data show decreased activity against Omicron variants. We evaluated the clinical efficacy and safety of TIX/CIL in LTRs during the Omicron wave. A prospective observational cohort study was conducted at ISMETT in Palermo (Italy). In June 2022, SARS-CoV-2 PrEP with TIX/CIL 150/150 mg was offered to LTRs. LTRs who received TIX/CIL were compared to LTRs who did not. Logistic regression analysis (adjusted for prior COVID-19, SARS-CoV-2 vaccination, age, years from transplant, and rejection) was performed. The objective of this study was to compare the following among the two populations: prevalence of SARS-CoV-2, length of SARS-CoV-2 positivity, and COVID-19 disease severity. Among 110 eligible LTRs, 79 (72%) received TIX/CIL and 31 (28%) did not. SARS-CoV-2 infections occurred in 6% (n = 5) of patients who received TIX/CIL and 29% (n = 9) of patients who did not (p < 0.001). In both groups, infections were mild/asymptomatic, and no one was hospitalized or died. At multivariate analysis, TIX/CIL was associated with a lower risk of infection (aOR 0.22; 95%CI 0.06-0.78; p = 0.02). TIX/CIL was safe and effective in reducing the risk of SARS-CoV-2 in LTRs during the Omicron wave.
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Affiliation(s)
- Andrea Cona
- Department of Infectious Diseases, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy; (S.A.); (A.M.)
| | - Alessandro Tavelli
- Unit of Infectious Diseases, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20146 Milan, Italy;
| | - Stefano Agrenzano
- Department of Infectious Diseases, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy; (S.A.); (A.M.)
- Infectious Diseases Unit, ARNAS “Civico-Di Cristina-Benfratelli”, 90127 Palermo, Italy
| | - Neha Hafeez
- Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA;
| | - Giovanni Scianna
- Transplant Coordinator Nurses, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy; (G.S.); (A.M.)
| | - Angelo Maria
- Transplant Coordinator Nurses, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy; (G.S.); (A.M.)
| | - Francesco Marino
- Nursing Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy; (F.M.); (E.D.L.C.); (M.D.G.); (E.O.); (G.C.)
| | - Elizabeth De La Cruz
- Nursing Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy; (F.M.); (E.D.L.C.); (M.D.G.); (E.O.); (G.C.)
| | - Maria Di Giorgio
- Nursing Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy; (F.M.); (E.D.L.C.); (M.D.G.); (E.O.); (G.C.)
| | - Eglys Osorio
- Nursing Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy; (F.M.); (E.D.L.C.); (M.D.G.); (E.O.); (G.C.)
| | - Giuseppe Cucinella
- Nursing Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy; (F.M.); (E.D.L.C.); (M.D.G.); (E.O.); (G.C.)
| | - Angelo Luca
- Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy;
| | - Alessio Provenzani
- Clinical Pharmacy, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy;
| | - Patrizio Vitulo
- Division of Pulmonology, Chest Center Department, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy;
| | - Alessandro Bertani
- Division of Thoracic Surgery and Lung Transplantation, Chest Center Department, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy;
| | - Paolo Antonio Grossi
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, 21100 Varese, Italy;
| | - Alessandra Mularoni
- Department of Infectious Diseases, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy; (S.A.); (A.M.)
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Goodlet KJ, McCreary EK, Nailor MD, Barnes D, Brokhof MM, Bova S, Clemens E, Kelly B, Lichvar A, Pluckrose DM, Summers BB, Szempruch KR, Tchen S. Therapeutic Myths in Solid Organ Transplantation Infectious Diseases. Open Forum Infect Dis 2024; 11:ofae342. [PMID: 38983710 PMCID: PMC11232700 DOI: 10.1093/ofid/ofae342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 06/12/2024] [Indexed: 07/11/2024] Open
Abstract
Infection management in solid organ transplantation poses unique challenges, with a diverse array of potential pathogens and associated antimicrobial therapies. With limited high-quality randomized clinical trials to direct optimal care, therapeutic "myths" may propagate and contribute to suboptimal or excessive antimicrobial use. We discuss 6 therapeutic myths with particular relevance to solid organ transplantation and provide recommendations for infectious diseases clinicians involved in the care of this high-risk population.
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Affiliation(s)
- Kellie J Goodlet
- Department of Pharmacy Practice, Midwestern University, Glendale, Arizona, USA
| | - Erin K McCreary
- Department of Medicine, Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael D Nailor
- Department of Pharmacy Services, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Darina Barnes
- Department of Pharmacy, Comprehensive Transplant Center, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Marissa M Brokhof
- Department of Pharmacy, Rush University Medical Center, Chicago, Illinois, USA
| | - Sarah Bova
- Department of Pharmacy, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Evan Clemens
- Department of Pharmacy, University of Washington Medical Center, Seattle, Washington, USA
| | - Beth Kelly
- Department of Pharmacy, Indiana University Health, Indianapolis, Indiana, USA
| | - Alicia Lichvar
- Center for Transplantation, UC San Diego Health, San Diego, California, USA
| | - Dawn M Pluckrose
- Department of Pharmacy, Tufts Medical Center, Boston, Massachusetts, USA
| | - Bryant B Summers
- Comprehensive Transplant Center, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kristen R Szempruch
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Stephanie Tchen
- Department of Pharmacy, Froedtert Hospital, Milwaukee, Wisconsin, USA
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Reemann L, Kneidinger N, Sczepanski B, Koczulla AR. COVID-19 in Lung Transplant Recipients: A Report on 10 Recent Cases. Viruses 2024; 16:709. [PMID: 38793590 PMCID: PMC11126037 DOI: 10.3390/v16050709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/23/2024] [Accepted: 04/26/2024] [Indexed: 05/26/2024] Open
Abstract
Due to immunosuppression, transplant recipients are at higher risk of infections with SARS-CoV-2 and worse clinical outcomes than immunocompetent hosts. Furthermore, lung transplant patients represent a special group among solid organ recipients, since pneumonia is the main manifestation of COVID-19. However, data on the course of disease and the changes in morbidity and mortality during the course of the pandemic are limited. In our pulmonary rehabilitation clinic, we treat patients shortly after lung transplant as well as long-term transplant patients. Over the last almost 4 years of pandemic, we witnessed several COVID-19 infections in lung transplant patients in our clinic as well as patients who acquired an infection beforehand. In this paper, we aim at retrospectively describing a series of recent COVID-19 cases in our clinic, looking at the clinical course of disease and outcomes in lung transplant patients.
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Affiliation(s)
- Lea Reemann
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, 83471 Schoenau am Koenigssee, Germany; (B.S.); (A.R.K.)
| | - Nikolaus Kneidinger
- Department of Medicine V, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Ludwig-Maximilians University (LMU) University Hospital, 81377 Munich, Germany;
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, 8010 Graz, Austria
| | - Bernd Sczepanski
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, 83471 Schoenau am Koenigssee, Germany; (B.S.); (A.R.K.)
| | - Andreas Rembert Koczulla
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, 83471 Schoenau am Koenigssee, Germany; (B.S.); (A.R.K.)
- Department of Pulmonary Rehabilitation, Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Philipps-University of Marburg, 35043 Marburg, Germany
- Teaching Hospital, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
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Subramanian V. Susceptibility to SARS-CoV-2 Infection and Immune Responses to COVID-19 Vaccination Among Recipients of Solid Organ Transplants. J Infect Dis 2023; 228:S34-S45. [PMID: 37539762 PMCID: PMC10401623 DOI: 10.1093/infdis/jiad152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Abstract
Solid organ transplant recipients (SOTRs) are at high risk for infections including SARS-CoV-2, primarily due to use of immunosuppressive therapies that prevent organ rejection. Furthermore, these immunosuppressants are typically associated with suboptimal responses to vaccination. While COVID-19 vaccines have reduced the risk of COVID-19-related morbidity and mortality in SOTRs, breakthrough infection rates and death remain higher in this population compared with immunocompetent individuals. Approaches to enhancing response in SOTRs, such as through administration of additional doses and heterologous vaccination, have resulted in increased seroresponse and antibody levels. In this article, safety and immunogenicity of mRNA COVID-19 vaccines in SOTRs are explored by dose. Key considerations for clinical practice and the current vaccine recommendations for SOTRs are discussed within the context of the dynamic COVID-19 vaccination guideline landscape. A thorough understanding of these topics is essential for determining public health and vaccination strategies to help protect immunocompromised populations, including SOTRs.
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Affiliation(s)
- Vijay Subramanian
- Correspondence: Vijay Subramanian, MD, Tampa General Hospital, 409 Bayshore Blvd, Tampa, FL 33606 ()
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Kim HJ, Lee HJ, Yu S, Shin KH, Cho WH, Yeo HJ. Immunosuppressant and SARS-CoV-2 Vaccine Antibody Response After Lung Transplantation. Transplant Proc 2022; 54:2692-2697. [PMID: 36411096 PMCID: PMC9663737 DOI: 10.1016/j.transproceed.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There are insufficient reports on the immunogenicity and safety of the COVID-19 vaccination after lung transplantation in Korea. METHODS Between April and September 2021, lung transplant recipients (n = 52) and healthy controls (n = 22) underwent vaccination. The levels of antibodies were assessed prospectively at 4 weeks after priming and second dose. RESULTS Of a total of 52 lung transplant recipients, there were 84.6% nonresponders, 15.4% second-dose responders, and 0% primary dose responders. Among healthy controls, 63.6% were priming responders, and 18.2% were second-dose responders, and 18.2% were nonresponders. Compared with the control group, lung recipients were less likely to develop antibodies (P < .001). Antibody formation tended to be higher in recipients more than 1 year after transplantation (0 vs 20.5%, P = .076). No major safety events were reported, and the adverse symptoms were mild and consistent with those of the general population. In a multivariate regression analysis, mycophenolic acid levels (µg/mL) (odds ratio 0.25, P = .005) and tacrolimus level (ng/mL) (odds ratio 0.65, P = .035) were significantly associated with antibody formation. CONCLUSIONS The immunogenicity of the second dose of COVID-19 vaccination with various combinations was substantially low in lung transplants. A booster of the COVID-19 vaccine is warranted in lung transplants, especially a year later.
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Affiliation(s)
- Hye-Jin Kim
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Hyun Ji Lee
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Shinae Yu
- Department of Laboratory Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Kyung-Hwa Shin
- Department of Laboratory Medicine, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Woo Hyun Cho
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Hye Ju Yeo
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea,Address correspondence to Hye Ju Yeo, MD, PhD, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeumeup, Yangsan 50612, Republic of Korea
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López GMS, Moralejo RA, Roncal MP, Ortiz MTT, Loaiza CAQ, Rivilla AP, Gafas ADP. Immunity After Vaccination Against SARS-CoV-2 in Lung Transplant? Transplant Proc 2022; 54:2479-2481. [PMID: 36257877 PMCID: PMC9500086 DOI: 10.1016/j.transproceed.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/13/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND SARS-CoV2 infection causes high morbidity and mortality in lung transplant (LT) recipients. Vaccination with messenger RNA vaccines has been shown to play a key role in controlling the severity of infection in the general population. The aim of our study is to analyze whether vaccination with 2 doses of SARS-Cov2 provides immunity in LT recipients. METHODS Retrospective descriptive and analytical study of LT recipients vaccinated with 2 doses of SARS-CoV2. We analyzed the vaccine received, if they had COVID-19, antibody levels (antispike and antinucleoprotein), anticalcineurin levels, infections in the last year, and presence of neoplasias. RESULTS The most commonly administered vaccine was from Moderna, with 27% of patients showing immunity with a median antibody levels of 4.81 binding antibody units/mL, far from the values considered protective (> 34 binding antibody units/mL). Thirteen patients were infected with SARS-CoV2, 7 post vaccination (5 of them were antispike-positive). No relationship was demonstrated between generation of immunity and age and level of immunosuppression. CONCLUSIONS Vaccination against SARS-CoV2 in LT recipients generates limited and ineffective immunity with only 2 doses.
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Affiliation(s)
- Gema María Siesto López
- Pneumology Department, Universitary Hospital of Salamanca. P. San Vicente, Salamanca, Spain,Address correspondence to Gema María Siesto López, Salamanca University, Villamayor Avenue 64-68, 37007, Salamanca, Spain. Tel: +34652492954
| | - Rodrigo Alonso Moralejo
- Pneumology Department, Lung Transplant Unit, Hospital 12 de Octubre Av Córdoba s/n, Madrid, Spain
| | - María Piñeiro Roncal
- Pneumology Department, General Hospital of Segovia, C/de Luis Erik Clavería, Segovia, Spain
| | | | | | | | - Alicia De Pablo Gafas
- Pneumology Department, Lung Transplant Unit, Hospital 12 de Octubre Av Córdoba s/n, Madrid, Spain
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Evaluation of Immunogenicity to Three Doses of the SARS-CoV-2 BNT162b2 mRNA Vaccine in Lung Transplant Patients. Vaccines (Basel) 2022; 10:vaccines10101642. [PMID: 36298507 PMCID: PMC9609771 DOI: 10.3390/vaccines10101642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/16/2022] [Accepted: 09/23/2022] [Indexed: 11/09/2022] Open
Abstract
The aim of the study was to explore the humoral and T-cell response in lung transplant (LuT) patients. Two-time points were considered, before (T0) and after (Tpost) the third dose of the BNT162b2 mRNA vaccine, comparing LuT with healthy donors (HD). LuT patients showed a lower serologic response against SARS-CoV-2 compared with HD at both time-points (p = 0.0001 and p = 0.0011, respectively). A lower percentage of IFNγ+orIL2+orTNFα+CD4+ and CD8+ T-cells LuT patients was observed in LuT patients compared with HD at T0 (CD4+: p = 0.0001; CD8+: p = 0.0005) and Tpost (CD4+: p = 0.0028; CD8+: p = 0.0114), as well as in the percentage of IFNγ+IL2+TNFα+CD4+ T-cells (T0: p = 0.0247; Tpost: p = 0.0367). Finally, at Tpost, a lower percentage of IFNγ+IL2+TNFα+ CD8+ T-cells in LuT patients compared with HD was found (p = 0.0147). LuT patients were stratified according to the lowest cut-off value for the detection of a humoral response (4.81 BAU/mL) at T0, into responder (R) and non-responder (NR) groups. In the R group, no differences in the percentage of IFNγ+or IL2+orTNFα+ and IFNγ+IL2+TNFα+CD4+ and CD8+ T-cells compared with HD at both time-points were observed. Otherwise, in the NR group, lower percentages of IFNγ+IL2+TNFα+CD4+ T-cells compared with the R group (T0: p = 0.0159; Tpost: p = 0.0159), as well as compared with the HD, at both time-points, were observed (T0: p = 0.0064; Tpost: p = 0.0064). These data seem to confirm that some LuT patients can mount cellular responses even in the absence of a positive humoral response (>33.8 BAU/mL), although this cellular response is dysfunctional and partially detrimental.
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COVID-Related Chronic Allograft Dysfunction in Lung Transplant Recipients: Long-Term Follow-up Results from Infections Occurring in the Pre-vaccination Era. TRANSPLANTOLOGY 2022. [DOI: 10.3390/transplantology3040028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: We report on characteristics and lung function outcomes among lung transplant recipients (LTRs) after COVID-19 with infections occurring in the first year of the coronavirus pandemic prior to introduction of the vaccines. Methods: This was a retrospective study of 18 LTRs who tested positive for SARS-CoV-2 between 1 February 2020 and 1 March 2021. The mean age was 49.9 (22–68) years; 12 patients (67%) were male. Two patients died due to severe COVID-19. Results: During the study period, there were 18 lung transplant recipients with a community-acquired SARS-CoV-2 infection. In this cohort, seven had mild, nine had moderate, and two had severe COVID-19. All patients with mild and moderate COVID-19 survived, but the two patients with severe COVID-19 died in the intensive care unit while intubated and on mechanical ventilation. Most patients with moderate COVID-19 showed a permanent lung function decrease that did not improve after 12 months. Conclusion: A majority of LTRs in the current cohort did not experience an alteration in the trajectory of FEV1 evolution after developing SARS-CoV-2 infection. However, in the patients with moderate COVID-19, most patients had a decline in the FEV1 that was present after 1 month after recovery and did not improve or even deteriorated further after 12 months. In LTRs, COVID-19 can have long-lasting effects on pulmonary function. Treatment strategies that influence this trajectory are needed.
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Bárczi E, Varga V, Nagy A, Eszes N, Jáky‐Kováts Z, Müller V, Bohács A. Serological findings following the second and third SARS-CoV-2 vaccines in lung transplant recipients. Immun Inflamm Dis 2022; 10:e646. [PMID: 35894705 PMCID: PMC9311263 DOI: 10.1002/iid3.646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Lung transplant recipients (LuTX) represent a vulnerable population for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Even though many vaccines are already developed, more clinical data need to support effective immunological response in immunocompromised patients. METHODS Stable LuTX recipients with no medical history of coronavirus disease (COVID-19) were enrolled. Currently available messenger RNA (mRNA) (BNT162b2-mRNA, mRNA-1273) and non-mRNA (ChAdOx1, BBIBP-CorV) vaccines were given according to availability, boosters were all mRNA-based. SARS-CoV-2 Spike1 immunoglobulin G (IgG) antibody titer was evaluated before and 2 weeks after second and third dose. Difference between mRNA versus non-mRNA vaccines was assessed. RESULTS Forty-one patients (49% men, age 48.4 ± 13.8 years) received two doses of SARS-CoV-2 vaccines: 23 of mRNA, 18 of non-mRNA, and 24/41 (58%) received a third dose. Median 92 months passed since transplantation, and serum level of tacrolimus was median 5.5 ng/ml. Positive serology was found in 37% of all patients after the second dose, 86% had mRNA vaccine. After the third dose, 29% became positive who had no antibody before. Significantly higher level of antibody was found after the second mRNA than non-mRNA vaccines (2.2 vs. 1568.8 U/ml, respectively, p = .002). 6/23 (26%) patients received two doses of mRNA vaccine developed COVID-19 after the second injection in an average of 178 days, half of them recovered, half of them died in intensive care unit (ICU). 3/6 (50%) patients with two doses mRNA and recovered from COVID-19 had significantly higher level of antibody (average 20847.3 U/ml) than without infection. After the booster vaccine, 1/24 (4%) developed infection. CONCLUSION Immunosuppression therapy may induce a weaker SARS-CoV-2 response in LuTX recipients; therefore, third dose is a priority in transplanted patients. The highest antibody level was measured recovering from COVID after two doses. Our data confirm that booster mRNA vaccine could increase antibody levels, even if immunization was started with non-mRNA vaccine.
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Affiliation(s)
- Enikő Bárczi
- Department of Pulmonology, Faculty of MedicineSemmelweis UniversityBudapestHungary
| | - Viktória Varga
- Department of Pulmonology, Faculty of MedicineSemmelweis UniversityBudapestHungary
| | - Alexandra Nagy
- Department of Pulmonology, Faculty of MedicineSemmelweis UniversityBudapestHungary
| | - Noémi Eszes
- Department of Pulmonology, Faculty of MedicineSemmelweis UniversityBudapestHungary
| | | | - Veronika Müller
- Department of Pulmonology, Faculty of MedicineSemmelweis UniversityBudapestHungary
| | - Anikó Bohács
- Department of Pulmonology, Faculty of MedicineSemmelweis UniversityBudapestHungary
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Lung Transplant Recipients Immunogenicity after Heterologous ChAdOx1 nCoV-19—BNT162b2 mRNA Vaccination. Viruses 2022; 14:v14071470. [PMID: 35891450 PMCID: PMC9316698 DOI: 10.3390/v14071470] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/17/2022] [Accepted: 06/29/2022] [Indexed: 02/01/2023] Open
Abstract
(1) Background: High immunosuppressive regimen in lung transplant recipients (LTRs) hampers the immune response to vaccination. We prospectively investigated the immunogenicity of heterologous ChAdOx1 nCoV-19-BNT162b2 mRNA vaccination in an LTR cohort. (2) Methods: Forty-nine COVID-19 naïve LTRs received a two-dose regimen ChAdOx1 nCoV-19 vaccine. A subset of 32 patients received a booster dose of BNT162b2 mRNA vaccine 18 weeks after the second dose. (3) Results: Two-doses of ChAdOx1 nCoV-19 induced poor immunogenicity with 7.2% seropositivity at day 180 and low neutralizing capacities. The BNT162b2 mRNA vaccine induced significant increases in IgG titers with means of 197.8 binding antibody units per milliliter (BAU/mL) (95% CI 0–491.4) and neutralizing antibodies, with means of 76.6 AU/mL (95% CI 0–159.6). At day 238, 32.2% of LTRs seroconverted after the booster dose. Seroneutralization capacities against Delta and Omicron variants were found in only 13 and 9 LTRs, respectively. Mycophenolate mofetil and high-dose corticosteroids were associated with a weak serological response. (4) Conclusions: The immunogenicity of a two-dose ChAdOx1 nCoV-19 vaccine regimen was very poor in LTRs, but was significantly enhanced after the booster dose in one-third of LTRs. In immunocompromised individuals, the administration of a fourth dose may be considered to increase the immune response against SARS-CoV-2.
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12
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The effect of COVID 19 vaccination on kidney recipients. Transpl Immunol 2022; 74:101658. [PMID: 35777613 PMCID: PMC9238056 DOI: 10.1016/j.trim.2022.101658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/25/2022] [Accepted: 06/25/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Nearly one year from the onset of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, safe and effective vaccines began distribution around the world. This study aimed to assess the rate of COVID-19 disease among vaccinated kidney transplant patients and the types of symptoms found within them. DESIGN This cross-sectional study was performed at the transplant ward and Organ Procurement Unit of Sina Hospital, Tehran, Iran. As a sample size, 159 cadavers' kidney recipients received two doses of the Sinopharm SARS-CoV-2 vaccine. The required data were collected using a checklist via conducting a face-to-face interview. RESULTS The mean age of the vaccinated participants was 49.44 ± 13.87 years old. There were 73 (45.91%) vaccinated cases of SARS-CoV-2 infection during the study period, 18 cases (12.6%) occurred among fully vaccinated individuals, and 53 cases (33.3%) were among individuals who had received only one dose of vaccine. 45% of the fully vaccinated patients (received 2 doses vaccine) contracted SARS-CoV-2 from their families; 35% were infected through participation in social events (35%). There was a significant difference in disease severity levels between the fully vaccinated group and the one-dose vaccinated (p < 0.023). The severe disease occurred in 2 patients after vaccination, who were subsequently admitted to the hospital. There was a significant difference between the number of kidney transplant days and infection with SARS-CoV-2 before (P = 0.15) and after vaccination (p < 0.015). CONCLUSION Even after vaccination, kidney recipients are still at the risk of contracting SARS-CoV-2. In addition to these results, the efficacy of vaccination in preventing death caused by SARS-CoV-2 was confirmed.
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Svorcova M, Novysedlak R, Lischke R, Vachtenheim J, Strizova Z. Vaccination Against SARS-CoV-2 in Lung Transplant Recipients: Immunogenicity, Efficacy and Safety. Front Immunol 2022; 13:906225. [PMID: 35720376 PMCID: PMC9198330 DOI: 10.3389/fimmu.2022.906225] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/05/2022] [Indexed: 12/17/2022] Open
Abstract
Lung transplant (LuTx) recipients are considered to be at higher risk of developing serious illness from COVID-19. COVID-19 vaccines were shown in randomized clinical trials to substantially reduce the severity of COVID-19, however, patients receiving immunosuppressants were excluded from these trials. Observational studies report a proportion of solid organ transplant (SOT) recipients being able to mount sufficient titers of SARS-CoV-2 specific IgG antibodies, however, other studies demonstrate that more than 90% of the SOT recipients elicit neither humoral nor cellular immune response after vaccination. Currently, the third booster dose of the COVID-19 vaccines was shown to elicit strong immune responses and may, thus, represent a potent tool in the prevention of severe COVID-19 infection in SOT recipients, including patients after lung transplantation. To address the main challenges of SARS-CoV-2 vaccination in LuTx recipients in the era of COVID-19, we have closely collected all available data on the immunogenicity, efficacy and safety of COVID-19 vaccines in LuTx recipients.
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Affiliation(s)
- Monika Svorcova
- Third Department of Surgery, Prague Lung Transplant Program, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Rene Novysedlak
- Third Department of Surgery, Prague Lung Transplant Program, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Robert Lischke
- Third Department of Surgery, Prague Lung Transplant Program, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Jiri Vachtenheim
- Third Department of Surgery, Prague Lung Transplant Program, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Zuzana Strizova
- Department of Immunology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
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14
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Bollineni S, Mahan LD, Lawrence A, Joerns J, Timofte I, Torres F, Kaza V, La Hoz RM, SoRelle JA, Kershaw CD, Terada LS, Zhang S, Mohanka MR, Banga A. COVID-19 vaccination is associated with favorable outcomes among lung transplant patients with breakthrough infections. Transplant Proc 2022; 54:1517-1523. [PMID: 35909014 PMCID: PMC9197779 DOI: 10.1016/j.transproceed.2022.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/26/2022] [Accepted: 05/31/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Srinivas Bollineni
- Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Luke D Mahan
- Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Adrian Lawrence
- Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - John Joerns
- Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Irina Timofte
- Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Fernando Torres
- Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Vaidehi Kaza
- Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ricardo M La Hoz
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeffrey A SoRelle
- Department of Genomics and Molecular Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Corey D Kershaw
- Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lance S Terada
- Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Song Zhang
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Manish R Mohanka
- Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Amit Banga
- Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
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15
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COVID-19 Vaccination in Lung Transplant Recipients. Indian J Thorac Cardiovasc Surg 2022; 38:347-353. [PMID: 35600498 PMCID: PMC9112254 DOI: 10.1007/s12055-022-01364-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/07/2022] [Accepted: 04/18/2022] [Indexed: 01/06/2023] Open
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16
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Ochman M, Latos M, Galle D, Niepokój K, Stącel T, Urlik M, Zawadzki F, Przybyłowski P. Coronavirus disease of 2019 (COVID-19) among lung transplant recipients – a single center study. Transplant Proc 2022; 54:913-916. [PMID: 35595560 PMCID: PMC8995323 DOI: 10.1016/j.transproceed.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 11/20/2022]
Abstract
Background When COVID-19 became a pandemic, it was difficult to predict how it would affect lung transplant recipients. The aim of this study was to assess the mortality, influence on graft function as well as attitude toward SARS-CoV-2 vaccination among lung transplant recipients from a single center. Methods We analyzed medical data pertaining to 124 recipients who received lung transplants between 2008-2021 from a single center and original questionnaire on the COVID-19 severity classification system and the patients’ attitude toward SARS-CoV-2 vaccination. Graft function was assessed by spirometry and a 6-minute walk test (6MWT), at least at the first postCOVID-19 visit. Results Among 29 patients who were confirmed to have COVID-19, 6 people died during or directly after contracting this infectious disease. The significant decrease in spirometry and distance in a 6MWT has been rarely observed in COVID-19 survivors. After vaccination ( n=107 patients) , most patients reported mild symptoms with slight pain and discomfort at the injection site being the most common (51.4%). 67.7% of all studiedpatients did not have any fears regarding the vaccination. Others reported being significantly worried about its effects (19.4% agreed to receive a vaccination anyway and 12.9% refused to be vaccinated). Conclusions COVID-19 may present significant mortality among lung transplant recipients. The short-term safety and outcomes of vaccinations among these patients seemed encouraging. We are aware of the small study group limitations and hope to research this issue further.
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Novysedlak R, Vachtenheim J, Stříž I, Viklický O, Lischke R, Strizova Z. SARS-CoV-2 viral load assessment in lung transplantation. Physiol Res 2021; 70:S253-S258. [PMID: 34913356 DOI: 10.33549/physiolres.934760] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In the era of COVID-19 pandemic, organ transplantation programs were facing serious challenges. The lung transplantation donor pool was extremely limited and SARS-CoV-2 viral load assessment has become a crucial part of selecting an optimal organ donor. Since COVID-19 is a respiratory disease, the viral load is thought to be more important in lung transplantations as compared to other solid organ transplantations. We present two challenging cases of potential lung donors with a questionable COVID-19 status. Based on these cases, we suggest that the cycle threshold (Ct) value should always be requested from the laboratory and the decision whether to proceed with transplantation should be made upon complex evaluation of diverse criteria, including the nasopharyngeal swab and bronchoalveolar lavage PCR results, the Ct value, imaging findings and the medical history. However, as the presence of viral RNA does not ensure infectivity, it is still to be clarified which Ct values are associated with the viral viability. Anti-SARS-CoV-2 IgA antibodies may support the diagnosis and moreover, novel methods, such as quantifying SARS-CoV-2 nucleocapsid antigen in serum may provide important answers in organ transplantations and donor selections.
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Affiliation(s)
- R Novysedlak
- Third Department of Surgery, Prague Lung Transplant Program, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic; Department of Immunology, Second Faculty of Medicine, Charles University and University Hospital Motol, Praha 5, Czech Republic.
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