key: cord-1005372-5wvo58ei
authors: Havlin, Jan; Svorcova, Monika; Dvorackova, Dr Eliska; Lastovicka, Dr Jan; Lischke, Robert; Kalina, Associate Professor Tomas; Hubacek, Petr
title: Immunogenicity of BNT162b2 mRNA COVID-19 Vaccine and SARS-CoV-2 Infection in Lung Transplant Recipients
date: 2021-05-21
journal: J Heart Lung Transplant
DOI: 10.1016/j.healun.2021.05.004
sha: 397673b8a19d4e9156e7d32df9ffb88c92b28678
doc_id: 1005372
cord_uid: 5wvo58ei

The immunogenicity of the novel mRNA COVID-19 vaccine in immunocompromised lung transplant recipients is still unknown. We compared the antibody response after the first and second doses of the BNT162b2 mRNA COVID-19 vaccine (Pfizer/BioNTech) with the response after natural SARS-CoV-2 infection in lung transplant recipients. None of the vaccinees tested after two doses of the mRNA BNT162b2 vaccine developed anti-SARS-CoV-2 IgG, while 85% patients presented an antibody response after SARS-CoV-2 infection. The absence of antibody response to vaccination led us to investigate the cellular response in a subset of patients. We detected SARS-CoV-2 specific T-cells in 4 out of 12 tested patients. Some patients therefore might have clinical benefit from the vaccine despite an absent antibody response. These results contrast with the excellent antibody response in immunocompetent individuals observed in mRNA BNT162b2 trials and indicate an urgent need to identify the best vaccine type and scheme for immunocompromised transplanted patients.

The immunogenicity of the novel mRNA COVID-19 vaccine in immunocompromised lung transplant recipients is still unknown. We compared the antibody response after the first and second doses of the BNT162b2 mRNA COVID-19 vaccine (Pfizer/BioNTech) with the response after natural SARS-CoV-2 infection in lung transplant recipients. None of the vaccinees tested after two doses of the mRNA BNT162b2 vaccine developed anti-SARS-CoV-2 IgG, while 85% patients presented an antibody response after SARS-CoV-2 infection. The absence of antibody response to vaccination led us to investigate the cellular response in a subset of patients. We detected SARS-CoV-2 specific T-cells in 4 out of 12 tested patients. Some patients therefore might have clinical benefit from the vaccine despite an absent antibody response. These results contrast with the excellent antibody response in immunocompetent individuals observed in mRNA BNT162b2 trials and indicate an urgent need to identify the best vaccine type and scheme for immunocompromised transplanted patients.

Lung Transplant Recipients (LTRs) are among the most vulnerable groups in the COVID-19 pandemic (mortality 14-39%). [1] [2] [3] [4] An early report provided evidence of a poor antibody response after the first mRNA vaccine dose in solid organ transplant recipients. 5 However, the immunogenicity of the novel mRNA COVID-19 complete 2-dose vaccine in LTRs is unknown to date. We compared the antibody response after the first and second doses of the BNT162b2 mRNA COVID-19 vaccine with the response after natural SARS-CoV-2 infection in LTRs.

We included 48 LTRs without history of SARS-CoV-2 infection who received the first (n=48) and overlapping 11mer peptides of the S-RBD protein (JPT peptides, Berlin, Germany). A T-cell response study is laborious and expensive. It requires a fresh blood draw delivered to the laboratory on the same day, therefore we selected only patients living in Prague and Central Bohemia who were willing and able to visit our hospital for the blood draw. A positive response required an increase of > 1.5 fold above the non-stimulated controls and detection of more than 20 responding cells as previously described for CMV specific T-cell detection. 6 The study was approved by the Motol University Hospital institutional review board and the participants provided written informed consent.

The Mann-Whitney test (2-tailed) was used for between-group comparison of numeric data, a chisquare test was used to test proportions. Statistical significance was set at p<0.05. The analyses were performed using Statistica TM version 13.5.0.17 (TIBCO Software).

SARS-CoV-2-specific IgG were not detected in any of the vaccinated LTRs after the first or second vaccine dose. Serum samples were available before the first dose (n=48; 100%), before the second dose (n=46; 95.8%), 7 days after the second dose (n=30; 62.5%) and 4-6 weeks after the second dose (n=21; 43.8%) (Table) . Two patients did not receive the second dose: one of them had an episode of acute cellular rejection and the other one was infected with SARS-CoV-2 at day 9 after the All three anti-SARS-CoV-2-specific IgG tests detected high levels of antibodies in all healthy volunteers after the second dose ( Figure 1 ).

The 

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COVID-19 in Lung Transplant Recipients

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