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. 2021 Jun 30;9(7):708.
doi: 10.3390/vaccines9070708.

Serological Response in Lung Transplant Recipients after Two Doses of SARS-CoV-2 mRNA Vaccines

Madhusudhanan Narasimhan  1 , Lenin Mahimainathan  1 , Andrew E Clark  1 , Amena Usmani  1 , Jing Cao  1 , Ellen Araj  1 , Fernando Torres  2 , Ravi Sarode  1   2 , Vaidehi Kaza  2 , Chantale Lacelle  1 , Alagarraju Muthukumar  1
Affiliations

Serological Response in Lung Transplant Recipients after Two Doses of SARS-CoV-2 mRNA Vaccines

Madhusudhanan Narasimhan et al. Vaccines (Basel). .

Abstract

Background: Lung-transplant (LT) recipients are at high risk for COVID-19 due to immunosuppression and respiratory tropism of SARS-CoV-2. The information on the effect of COVID-19 mRNA vaccines to elicit immunogenic responses after a two-dose (2D) regimen in LT recipients is sparse. Thus, we assessed the effect of Pfizer-BioNTech and Moderna mRNA vaccines' 2D regimen on anti-spike responses in immunocompromised LT recipients.

Methods: We utilized serum samples from LT recipients vaccinated for SARS-CoV-2 with 2D of either the Pfizer-BioNTech or Moderna vaccines and 2D-vaccinated naïve (non-transplanted and non-exposed to COVID-19) group. Antibody responses were assessed using the FDA-approved SARS-CoV-2 anti-nucleocapsid protein IgG assay (IgGNC), the SARS-CoV-2 anti-spike protein IgM assay (IgMSP), and the SARS-CoV-2 anti-spike protein IgG II assay (IgGSP). CD4+ T-cell activity was assessed as a marker of immune competence using the ImmuKnow® assay.

Results: About 25% (18/73) of SARS-CoV-2 uninfected-LT patients generated a positive spike-IgG response following 2D of vaccines, with 36% (9/25) in the Moderna cohort and only 19% (9/48) in the Pfizer cohort. 2D in LT patients elicited a significantly lesser median IgGSP response (1.7 AU/mL, 95% CI: 0.6-7.5 AU/mL) compared to non-transplanted, uninfected naïve subjects (14,209 AU/mL, 95% CI: 11,261-18,836 AU/mL; p < 0.0001). In LT patients, the Moderna-evoked seropositivity trend was higher than Pfizer.

Conclusion: 2D COVID-19 vaccination elicits a dampened serological response in LT patients. Whether assessing other arms of host immunity combined with a higher vaccine dose can better capture and elicit improved immunogenicity in this immunocompromised population warrants investigation.

Keywords: COVID-19 mRNA vaccines; IgG; IgM; SARS-CoV-2; Spike; lung transplantation; nucleocapsid; serological response; two doses.

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Conflict of interest statement

Abbott Diagnostics, while providing a part of the antibody testing reagents, did not have any role in the study’s design, collection, analyses, or interpretation of the data; drafting the manuscript; or in the decision to publish the results. The authors declare no other conflicts of interest.

Figures

Figure 1
Figure 1
Frequency distribution of IgGSP versus days after the second dose of COVID-19 vaccines in LT recipients (a) BNT162b2 (Pfizer-BioNTech); (b) mRNA-1273 (Moderna). DA2D, days after the second dose of COVID-19 vaccines; prior-infected, pink-filled circle (Figure 1a); broken red and blue lines, IgGSP serology assay’s manufacturer-recommended positive cut-off value.
Figure 2
Figure 2
IgGSP levels in naïve subjects and LT patients after 2 doses of COVID-19 vaccine. NA2D, naïve subjects (non-transplanted and not had previous SARS-CoV-2 infection) after 2 doses of vaccine; TA2D, LT patients after 2 doses of vaccine; thick red line, median value.
Figure 3
Figure 3
Evaluation of immunogenicity following the double-dose Pfizer and Moderna vaccine regimen in LT recipients. Thick red line, median value; median (95% CI) (Pfizer—0.9 (0.0–4.1); Moderna—20.6 (0.8–80.2)).
See this image and copyright information in PMC

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