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Meta-Analysis
. 2022 Aug 19;14(8):1822.
doi: 10.3390/v14081822.

A Systematic Review and Meta-Analysis of Serologic Response following Coronavirus Disease 2019 (COVID-19) Vaccination in Solid Organ Transplant Recipients

Atsushi Sakuraba  1 , Alexander Luna  1 , Dejan Micic  1
Affiliations
Meta-Analysis

A Systematic Review and Meta-Analysis of Serologic Response following Coronavirus Disease 2019 (COVID-19) Vaccination in Solid Organ Transplant Recipients

Atsushi Sakuraba et al. Viruses. .

Abstract

Solid organ transplant (SOT) recipients are at greater risk of coronavirus disease 2019 (COVID-19) and have attenuated response to vaccinations. In the present meta-analysis, we aimed to evaluate the serologic response to the COVID-19 vaccine in SOT recipients. A search of electronic databases was conducted to identify SOT studies that reported the serologic response to COVID-19 vaccination. We analyzed 44 observational studies including 6158 SOT recipients. Most studies were on mRNA vaccination (mRNA-1273 or BNT162b2). After a single and two doses of vaccine, serologic response rates were 8.6% (95% CI 6.8-11.0) and 34.2% (95% CI 30.1-38.7), respectively. Compared to controls, response rates were lower after a single and two doses of vaccine (OR 0.0049 [95% CI 0.0021-0.012] and 0.0057 [95% CI 0.0030-0.011], respectively). A third dose improved the rate to 65.6% (95% CI 60.4-70.2), but in a subset of patients who had not achieved a response after two doses, it remained low at 35.7% (95% CI 21.2-53.3). In summary, only a small proportion of SOT recipients achieved serologic response to the COVID-19 mRNA vaccine, and that even the third dose had an insufficient response. Alternative strategies for prophylaxis in SOT patients need to be developed. Key Contribution: In this meta-analysis that included 6158 solid organ transplant recipients, the serologic response to the COVID-19 vaccine was extremely low after one (8.6%) and two doses (34.2%). The third dose of the vaccine improved the rate only to 66%, and in the subset of patients who had not achieved a response after two doses, it remained low at 36%. The results of our study suggest that a significant proportion of solid organ transplant recipients are unable to achieve a sufficient serologic response after completing not only the two series of vaccination but also the third booster dose. There is an urgent need to develop strategies for prophylaxis including modified vaccine schedules or the use of monoclonal antibodies in this vulnerable patient population.

Keywords: COVID-19; heart transplant; immunocompromised; kidney transplant; lung transplant; meta-analysis; outcomes; solid organ transplant; vaccine.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the assessment of the studies identified in the meta-analysis.
Figure 2
Figure 2
(A) Meta-analysis of serological response after one dose of vaccine: mRNA vaccines. (B) Meta-analysis of serological response after two doses of vaccine: mRNA vaccines.
Figure 3
Figure 3
(A) Meta-analysis of serological response compared to controls after one dose of vaccine. (B) Meta-analysis of serological response compared to controls after two doses of vaccine.
Figure 4
Figure 4
(A) Meta-analysis of serological response after three doses of vaccine. (B) Meta-analysis of serological response after three doses of vaccine among non-responders to two doses.
See this image and copyright information in PMC

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