Background

While several studies have observed that solid organ transplant recipients experience diminished antibody responses to SARS-CoV-2 mRNA vaccination, data specific to heart and lung transplant (HT/LT) recipients remains sparse.

Methods

US adult HT and LT recipients completed their vaccine series between January 7 and April 10, 2021. Reactogencity and SARS-CoV-2 anti-spike antibody were assessed after a priming dose (D1) and booster dose (D2). Modified Poisson regression with robust variance estimator was used to evaluate associations between participant characteristics and antibody development.

Results

Of 134 heart recipients, there were 38% non-responders (D1-/D2-), 48% booster responders (D1-/D2+), and 14% priming dose responders (D1+/D2+). Of 103 lung recipients, 64% were non-responders, 27% were booster responders, and 9% were priming dose responders. Lung recipients were less likely to develop antibodies (p < .001). Priming dose antibody response was associated with younger recipient age (p = .04), transplant-to-vaccination time ≥6 years (p < .01), and lack of anti-metabolite maintenance immunosuppression (p < .001). Pain at injection site was the most commonly reported reaction (85% after D1, 76% after D2). Serious reactions were rare, the most common being fatigue (2% after D1 and 3% after D2). No serious adverse events were reported.

Conclusions

HT and LT recipients experienced diminished antibody response following vaccination; reactogenicity was comparable to that of the general population. LT recipients may exhibit a more impaired antibody response than HT recipients. While current recommendations are to vaccinate eligible candidates and recipients, further studies characterizing the cell-mediated immune response and clinical efficacy of these vaccines in this population are needed.

中文翻译：

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SARS-CoV-2 信使 RNA 疫苗抗体反应和心肺移植受者的反应原性

背景

虽然几项研究观察到实体器官移植受者对 SARS-CoV-2 mRNA 疫苗接种的抗体反应减弱，但针对心脏和肺移植 (HT/LT) 受者的数据仍然很少。

方法

美国成人 HT 和 LT 接受者在 2021 年 1 月 7 日至 4 月 10 日期间完成了他们的疫苗系列。在初始剂量 (D1) 和加强剂量 (D2) 后评估了反应原性和 SARS-CoV-2 抗尖峰抗体。使用具有稳健方差估计器的修正泊松回归来评估参与者特征与抗体发展之间的关联。

结果

在 134 名心脏接受者中，有 38% 的无反应者 (D1-/D2-)、48% 的加强反应者 (D1-/D2+) 和 14% 的初始剂量反应者 (D1+/D2+)。在 103 名肺受者中，64% 为无反应者，27% 为加强反应者，9% 为初始剂量反应者。肺受者产生抗体的可能性较小（p < .001）。初免剂量抗体反应与较年轻的受者年龄 ( p  = .04)、移植到接种疫苗的时间≥6 年 ( p < .01) 以及缺乏抗代谢物维持免疫抑制 ( p< .001）。注射部位疼痛是最常报告的反应（第 1 天后 85%，第 2 天后 76%）。严重反应很少见，最常见的是疲劳（第 1 天后为 2%，第 2 天后为 3%）。没有报告严重的不良事件。

结论

HT 和 LT 受者在接种疫苗后抗体反应减弱；反应原性与一般人群相当。LT 受者可能比 HT 受者表现出更受损的抗体反应。虽然目前的建议是为符合条件的候选者和接受者接种疫苗，但需要进一步研究表征这些疫苗在该人群中的细胞介导的免疫反应和临床功效。