key: cord-0813793-5bug414c
authors: Blumberg, Emily A.; Manuel, Oriol; Sester, Martina; Ison, Michael G.
title: The future of SARS‐CoV‐2 vaccines in transplant recipients: To be determined
date: 2021-04-19
journal: Am J Transplant
DOI: 10.1111/ajt.16598
sha: 8994b4c95425bceea8445663cfbd5ffcb41ba862
doc_id: 813793
cord_uid: 5bug414c

The increasing availability of SARS-CoV-2 vaccines has been heralded as the intervention that will finally stem the COVID-19 pandemic. However, it is unclear how immunosuppressed patients, including solid organ transplant recipients will respond to vaccination. Given the smaller numbers of affected patients, compared with vaccine trials in the general population, the changing epidemiology of the pandemic with the emergence of concerning viral variants, and greater precautionary measure adherence, it may be difficult to determine efficacy in this population. Consequently, assessment of immunogenicity, including measurement of antibodies to the spike receptor-binding domain and evaluation of cellular responses, provides important information to define the host response to this vaccine.

The increasing availability of SARS-CoV-2 vaccines has been heralded as the intervention that will finally stem the COVID-19 pandemic.

However, it is unclear how immunosuppressed patients, including solid organ transplant recipients, will respond to vaccination. Given the smaller numbers of affected patients, compared with vaccine trials in the general population, the changing epidemiology of the pandemic with the emergence of concerning viral variants, and greater precautionary measure adherence, it may be difficult to determine efficacy in this population. Consequently, the assessment of immunogenicity, including measurement of antibodies to the spike receptorbinding domain and evaluation of cellular responses, provides important information to define the host response to this vaccine.

The first immunogenicity results following first doses of mRNA vaccines from a large and relatively diverse group of transplant recipients, identified via social media enrollment have been published. 1 The sharing of preliminary results focused solely on antibody measurements following a single-dose vaccine series is unusual and may be confusing to those looking for data to inform vaccine use in transplant recipients. This study used samples from standard venipuncture or novel home collection devices with two different commercial assays to detect SARS-CoV-2 spike antibody responses. After the first dose of the mRNA-based COVID-19 vaccine, the authors observed that less than 20% of patients had detectable antibodies, with the lowest response in those receiving anti-proliferative medications (e.g., mycophenolic acid) and older individuals; the impact of age has previously also been noted in non-immunosuppressed individuals. Transplant recipients have also expressed concern after dissemination of these preliminary data via lay press reports. Transplant 

Immunogenicity of a single dose of SARS-CoV-2 messenger RNA vaccine in solid organ transplant recipients

Age-dependent immune response to the Biontech/Pfizer BNT162b2 COVID-19 vaccination

Safety of the first dose of SARS-CoV-2 vaccination in solid organ transplant recipients

Alternative strategies of posttransplant influenza vaccination in adult solid organ transplant recipients

Weak anti-SARS-CoV-2 antibody response after the first injection of an mRNA COVID-19 vaccine in kidney transplant recipients

Kidney transplant recipients rarely show an early antibody response following the first COVID-19 vaccine administration

Efficacy and safety of the mRNA-1273 SARS-CoV-2 Vaccine

Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine

SARS-CoV-2 vaccination and solid organ transplant patients: data needed to inform safety and efficacy