key: cord-0826825-lnqhm5ya
authors: Boyarsky, Brian J.; Barbur, Iulia; Chiang, Teresa Po-Yu; Ou, Michael T.; Greenberg, Ross S.; Teles, Aura T.; Krach, Michelle R.; López, Julia I.; Garonzik-Wang, Jacqueline M.; Avery, Robin K.; Massie, Allan B.; Segev, Dorry L.; Werbel, William A.
title: SARS-CoV-2 Messenger RNA Vaccine Immunogenicity in Solid Organ Transplant Recipients With Prior COVID-19
date: 2021-07-19
journal: Transplantation
DOI: 10.1097/tp.0000000000003900
sha: 9d07471ccc89364b0e0d9c7f49246bcf1fbb5c6c
doc_id: 826825
cord_uid: lnqhm5ya

nan

I mmunocompetent people with prior severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (convalescent individuals) have been shown to have a more robust antibody response to the first SARS-CoV-2 mRNA vaccine dose compared with previously uninfected people (naive individuals). 1 Given limited immunogenicity of SARS-CoV-2 vaccines in solid organ transplant recipients, 2,3 we sought to quantify the antibody response to vaccination among convalescent versus naive transplant recipients.

Leveraging our ongoing prospective cohort of transplant recipients who underwent SARS-CoV-2 mRNA vaccination December 18, 2020-April 1, 2021, 4 we compared antispike antibody titers after dose 1 in convalescent transplant recipients with prior polymerase chain reaction-confirmed SARS-CoV-2 infection at a median (interquartile range [IQR]) of 3.5 mo (2.6-5.3 mo) before vaccination (n = 28) versus naive recipients (n = 1012) using weightedby-the-odds Poisson regression. As previously reported, serologic testing was conducted on the Roche Elecsys anti-SARS-CoV-2 S enzyme immunoassay (range, <0.4 to >250 U/mL [positive ≥0.8 U/mL]), which tests for antibodies against the receptor-binding domain of the spike protein, or the EUROIMMUN enzyme immunoassay (positive ≥1.1 AU), which tests for immunoglobulin G to the S1 domain of the spike protein. This study was approved by the Johns Hopkins Institutional Review Board.

Convalescent vaccinees were more likely to have a positive antibody response to dose 1 compared with naive vaccinees (89% versus 18%, P < 0.001) ( Table 1) . After weighting to adjust for age, antimetabolite therapy, and organ transplant type, prior SARS-CoV-2 infection was associated with a 6.28fold higher chance of a positive antibody response (weighted incidence rate ratio = 5.23 6.28 7.54 , P < 0.001). Convalescent vaccinees also had a higher post-dose 1 antispike antibody titer than naive vaccinees (median [ EUROIMMUN] ). In a sensitivity analysis restricting to only those with a confirmed prevaccine negative antibody result, convalescent recipients were still more likely to have a positive antibody response to dose 1 (75% versus 19%, P < 0.001).

Prevaccine antispike antibody testing was available in 12 of the 28 convalescent recipients and detectable in 8 of 12 (67%). In this population, postvaccine titers were higher than those prevaccine (>250 versus 223.3 U/mL [Roche]; 9.14 versus 5.5 AU [EUROIMMUN] ).

Limitations include a convenience sample, which may limit generalizability; inclusion of late entries, which limited the availability of prevaccination titers; self-report of SARS-CoV-2, which may have led to information bias; and lack of data on whether antimetabolite immunosuppression was held at the time of SARS-CoV-2 infection.

In this study of transplant recipients with prior SARS-CoV-2 infection, antibody response to vaccination was much stronger than in SARS-CoV-2 naive recipients. 

Antibody responses in seropositive persons after a single dose of SARS-CoV-2 mRNA vaccine

Antibody response to 2-dose SARS-CoV-2 mRNA vaccine series in solid organ transplant recipients

Antibody response to the Janssen COVID-19 vaccine in solid organ transplant recipients

Antibody response to a single dose of SARS-CoV-2 mRNA vaccine in patients with rheumatic and musculoskeletal diseases

Antibody response to first BNT162b2 dose in previously SARS-CoV-2-infected individuals