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. 2022 Aug;28(8):1153-1158.
doi: 10.1016/j.jiac.2022.04.019. Epub 2022 May 17.

Efficacy and safety of mRNA SARS-CoV-2 vaccines in lung transplant recipients

Takashi Hirama  1 , Miki Akiba  2 , Yuki Shundo  3 , Tatsuaki Watanabe  4 , Yui Watanabe  5 , Hisashi Oishi  6 , Hiromichi Niikawa  7 , Yoshinori Okada  8
Affiliations

Efficacy and safety of mRNA SARS-CoV-2 vaccines in lung transplant recipients

Takashi Hirama et al. J Infect Chemother. 2022 Aug.

Abstract

Background: To date, reports addressing the antibody response following mRNA SARS-CoV-2 vaccination in lung transplant (LTX) recipients are limited. Thus, the aim of this clinical study was to investigate the efficacy and safety of the vaccines in LTX recipients compared to controls.

Methods: An open-label, nonrandomized prospective study was conducted at Tohoku University Hospital. LTX recipients and controls who received either the BNT162b2 vaccine or the mRNA-1273 vaccine were recruited, and SARS-CoV-2 IgG was measured before and after vaccination. The adverse events were reviewed. Predictors of negative serology after vaccination were evaluated with logistic regression.

Results: Forty-one LTX recipients and 24 controls were analyzed. Although all controls had a positive antibody response to a SARS-CoV-2 mRNA vaccine, antibody response was found in 24.4% of LTX recipients (p < .0001). The amount of SARS-CoV-2 IgG following the 2nd dose significantly climbed to 6557 AU/mL in controls, whereas the increase in IgG in LTX recipients was 8.3 AU/mL (p < .0001). Fewer LTX recipients developed systemic fever than controls (p < .0001) despite equivalent overall adverse event percentages in both groups. A higher plasma concentration of mycophenolate was a significant predictor of negative serology (p = .032).

Conclusions: An impaired antibody response to mRNA vaccines was significantly found in LTX recipients compared to controls and was associated with the plasma concentration of mycophenolate. While repeating mRNA vaccination may be one of the strategies to improve antibody response given the safety of the vaccines, emerging data on humoral immune responses based on immunosuppression regimens in LTX recipients should be studied (jRCT1021210009).

Keywords: COVID-19; Japan; Lung transplantation; SARS-CoV-2; Vaccine; mRNA.

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Figures

Fig. 1
Fig. 1
Study flowchart LTX, lung transplant.
Fig. 2
Fig. 2
The trends in SARS-CoV-2 IgG before and after mRNA vaccination in LTR recipients (N = 41) and controls (N = 24) IQR, interquartile range; and LTX, lung transplant.
Fig. 3
Fig. 3
Percentages of various adverse events occurring in LTX recipients (N = 41) and controls (N = 24) LTX, lung transplant.
See this image and copyright information in PMC

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