key: cord-0923411-7mzkt3py
authors: Boyarsky, Brian J.; Chiang, Teresa P.-Y.; Teles, Aura T.; Greenberg, Ross S.; Krach, Michelle R.; Ou, Michael T.; Massie, Allan B.; Tobian, Aaron A. R.; Garonzik-Wang, Jacqueline M.; Segev, Dorry L.; Werbel, and William A.
title: Antibody Kinetics and Durability in SARS-CoV-2 mRNA Vaccinated Solid Organ Transplant Recipients
date: 2021-06-25
journal: Transplantation
DOI: 10.1097/tp.0000000000003863
sha: 8bd05d534cbb9ea28d6c921677c62bfde8f1961b
doc_id: 923411
cord_uid: 7mzkt3py

nan

D ecline in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antispike antibodies over time following natural infection and vaccination have been reported, 1-3 though kinetics and durability of antispike antibodies in vaccinated transplant recipients are unknown. We sought to quantify antispike antibody titers over a 3 mo period in transplant recipients who completed the mRNA vaccine series.

As previously reported, 4 Among the participants with detectable antibody at 1 mo, 6/169 (4%) fell below the threshold of positivity at 3 mo (Table 1) Negative sero-response was defined per manufacturer data as EUROIMMUN anti-S1 IgG <1.1 arbitrary units (AU) or Roche Elecsys anti-RBD pan Ig <0.8 units/mL. Low-positive sero-response was defined as anti-S1 IgG 1.1-4 AU or anti-RBD pan Ig 0.8-50 units/mL. High-positive seroresponse was defined as anti-S1 IgG >4 AU or anti-RBD pan Ig >50 units/mL. IgG, immunoglobulin G; RBD, receptorbinding domain; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.

became high-positive. Among those with high-positive titers at 1 mo, 18/94 (19%) dropped to the low-positive range and 75/94 (80%) remained high-positive. In this study of antibody kinetics and durability following SARS-CoV-2 mRNA vaccination, 43% experienced an increase antibody titer, 35% decreased, and 21% remained stable between 1 and 3 mo postvaccination. Though only a small minority (4%) who had detectable antibody at 1 mo fell below the threshold of detectability at 3 mo, 19% with high-positive titers at 1 mo dropped to low-positive.

In the mRNA-1273 trial, binding antibody levels declined slightly over time, but remained elevated at 3 mo after the completion of the 2-dose series. 1 It is unknown if antibody decline over time results in higher risk of SARS-CoV-2 infection; however, these results raise the suggestion that additional booster dosing may help augment lower antibody responses in transplant recipients.

This study is limited by convenience sampling, lack of immunocompetent control group, and lack of exploration of neutralizing antibody and memory B immune response. Also, despite clinical screening for incident symptomatic coronavirus disease 2019, antinucleocapsid testing was not performed, precluding analysis of asymptomatic exposure.

In conclusion, we found that antispike antibody seroresponse 3 mo following the mRNA vaccine series was largely stable. Understanding longitudinal kinetics of antibody decline among transplant recipients in the context of thresholds for protection may inform need and timing for booster vaccinations.

mRNA-1273 Study Group. Durability of responses after SARS-CoV-2 mRNA-1273 vaccination

Change in antibodies to SARS-CoV-2 over 60 days among health care personnel in

Durability of mRNA-1273-induced antibodies against SARS-CoV-2 variants

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

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