Background: Current evidence suggests that the immunogenicity of SARS-CoV-2 vaccine is suboptimal in solid organ transplant (SOT) recipients. Todate, no study has assessed the relationship between vaccination responseand the patient net state of immunosuppression (NSI). We investigated thehumoral response to SARS-CoV-2 vaccine in SOT recipients after the 1 stvaccination dose, and its relationship with several parameters of patient NSIat baseline.Methods: Prospective cohort study of SOT recipients vaccinated at ourhospital with mRNA-based vaccines. The immune response was evaluateddetermining the level of anti-receptor binding domain (RBD) of SARS-CoV-2antibodies at the time of 2 nd vaccination dose. In addition, an attempt toinvestigate the NSI was made at baseline (1 stdose) by determining absoluteCD4 and CD8 counts, IgG and C3 levels.Results: We enrolled 323 SOT recipients: 66.4% male, median age 57(IQR 49-67) years. Of them, 183 were kidney, 106 liver, 26 heart and 8 lungtransplant recipients. Overall response to 1st vaccination dose (RBD-anti-body titer ≥ 0.8 U/ml) was detected in 92 patients (28%). Seroconversionrates across transplant types were 44% in liver, 23% in kidney, 12% in lung,and 7% in heart recipients. The median RBD-antibody titer was 0.4 (IQR0.4-1.8) U/ml, with little variability between transplant types except for liverrecipients where the median titer was 0.41 with IQR 0.40-5.78. The NSI atbaseline was available for 178 out of the 323 included SOT patients. Com-parison of CD4, CD8, IgG and C3 between patients with and without anti-body response showed significant differences for absolute CD4 count 657(IQR 435-889) vs. 466 (IQR 290-656) p = 0.002, and IgG levels 1076 (IQR89-1239) vs. 937 (IQR 772-1114) p = 0.009.Conclusions: We confirmed a lower seroconversion rate after first vaccina-tion dose in a mixed cohort of SOT recipients. Baseline patient NSI, in par-ticular CD4 count and IgG levels, was associated with the response rate.
Pascale, R., Potena, L., Comai, G., Morelli, M.c., Salvaterra, E., La Manna, G., et al. (2021). SARS-CoV-2 VACCINATION AND EARLY SPECIFIC IMMUNE RESPONSE IN SOLID ORGAN TRANSPLANT RECIPIENTS.
SARS-CoV-2 VACCINATION AND EARLY SPECIFIC IMMUNE RESPONSE IN SOLID ORGAN TRANSPLANT RECIPIENTS
Pascale, R;Potena, L;Comai, G;La Manna, G;Pacini, D;Cescon, M;Lazzarotto, T;Viale, P;Giannella, M
2021
Abstract
Background: Current evidence suggests that the immunogenicity of SARS-CoV-2 vaccine is suboptimal in solid organ transplant (SOT) recipients. Todate, no study has assessed the relationship between vaccination responseand the patient net state of immunosuppression (NSI). We investigated thehumoral response to SARS-CoV-2 vaccine in SOT recipients after the 1 stvaccination dose, and its relationship with several parameters of patient NSIat baseline.Methods: Prospective cohort study of SOT recipients vaccinated at ourhospital with mRNA-based vaccines. The immune response was evaluateddetermining the level of anti-receptor binding domain (RBD) of SARS-CoV-2antibodies at the time of 2 nd vaccination dose. In addition, an attempt toinvestigate the NSI was made at baseline (1 stdose) by determining absoluteCD4 and CD8 counts, IgG and C3 levels.Results: We enrolled 323 SOT recipients: 66.4% male, median age 57(IQR 49-67) years. Of them, 183 were kidney, 106 liver, 26 heart and 8 lungtransplant recipients. Overall response to 1st vaccination dose (RBD-anti-body titer ≥ 0.8 U/ml) was detected in 92 patients (28%). Seroconversionrates across transplant types were 44% in liver, 23% in kidney, 12% in lung,and 7% in heart recipients. The median RBD-antibody titer was 0.4 (IQR0.4-1.8) U/ml, with little variability between transplant types except for liverrecipients where the median titer was 0.41 with IQR 0.40-5.78. The NSI atbaseline was available for 178 out of the 323 included SOT patients. Com-parison of CD4, CD8, IgG and C3 between patients with and without anti-body response showed significant differences for absolute CD4 count 657(IQR 435-889) vs. 466 (IQR 290-656) p = 0.002, and IgG levels 1076 (IQR89-1239) vs. 937 (IQR 772-1114) p = 0.009.Conclusions: We confirmed a lower seroconversion rate after first vaccina-tion dose in a mixed cohort of SOT recipients. Baseline patient NSI, in par-ticular CD4 count and IgG levels, was associated with the response rate.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
