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. 2023 Apr;25(2):e14055.
doi: 10.1111/tid.14055. Epub 2023 Mar 16.

High-titer post-vaccine COVID-19 convalescent plasma for immunocompromised patients during the first omicron surge

Ralph Tayyar  1 , Lisa Kanata Wong  2   3 , Alex Dahlen  4 , Elaine Shu  3 , Suchitra Pandey  2   3 , Anne Y Liu  1   5
Affiliations

High-titer post-vaccine COVID-19 convalescent plasma for immunocompromised patients during the first omicron surge

Ralph Tayyar et al. Transpl Infect Dis. 2023 Apr.

Abstract

Background: Transplant and hematologic malignancy patients have high Coronavirus disease 2019 (COVID-19) mortality and impaired vaccination responses. Omicron variant evades several monoclonal antibodies previously used in immunocompromised patients. Polyclonal COVID-19 convalescent plasma (CCP) may provide broader neutralizing capacity against new variants at high titers. Vaccination increases severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) titer in convalescent donors.

Methods: We conducted a retrospective chart review of hospitalized immunocompromised patients with COVID-19 who received high-titer CCP during the first omicron surge, collected from vaccinated donors within 6 months of pre-omicron COVID-19. Data on safety and outcomes were extracted.

Results: A total of 44 immunocompromised patients were included, 59.1% with solid organ transplant, 22.7% with hematopoietic cell transplant, 11.4% with hematologic malignancy, and 6.8% with autoimmune disease. Overall, 95% of CCP units transfused were from recently recovered and vaccinated donors and had SARS-CoV-2 antibody results 8- to 37-fold higher than the Food and Drug Administration's cutoff for high-titer CCP. There were two mild transfusion reactions. A total of 30-day mortality was 4.5%. There were no differences in 100-day mortality by underlying diagnosis, levels of immunosuppression, and timing of CCP administration. Patients with higher immunosuppression had significantly higher mean World Health Organization clinical progression scores at 30-day post-CCP compared to those with lower immunosuppression.

Conclusions: CCP is a safe, globally available treatment for immunocompromised patients with COVID-19. Mortality was lower in our cohort than that of COVID-19 patients with similar immunocompromising conditions. Post-vaccine CCP with very high titers should be prioritized for study in immunocompromised patients. Post-vaccine CCP has the potential to keep pace with new variants by overcoming mutations at sufficiently high titer.

Keywords: COVID-19 convalescent plasma; SARS-CoV-2; hematopoietic cell transplant; immunocompromised patients; solid organ transplant.

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References

REFERENCES

    1. Ge E, Li Y, Wu S, Candido E, Wei X. Association of pre-existing comorbidities with mortality and disease severity among 167,500 individuals with COVID-19 in Canada: a population-based cohort study. PLoS One. 2021;16(10):e0258154. doi:10.1371/journal.pone.0258154
    1. Shin HJ, Chow R, Noh H, et al. The association between immunosuppressants use and COVID-19 adverse outcomes: national COVID-19 cohort in South Korea. Ann Palliat Med. 2022;11(4):1308-1316. doi:10.21037/apm-21-3465
    1. Tenforde MW, Self WH, Adams K, et al. Association between mRNA vaccination and COVID-19 Hospitalization and disease severity. JAMA. 2021;326(20):2043-2054. doi:10.1001/jama.2021.19499
    1. Luxi N, Giovanazzi A, Capuano A, et al. COVID-19 vaccination in pregnancy, paediatrics, immunocompromised patients, and persons with history of allergy or prior SARS-CoV-2 infection: overview of current recommendations and pre- and post-marketing evidence for vaccine efficacy and safety. Drug Saf. 2021;44(12):1247-1269. doi:10.1007/s40264-021-01131-6
    1. Boyarsky BJ, Werbel WA, Avery RK, et al. Antibody response to 2-dose SARS-CoV-2 mRNA vaccine series in solid organ transplant recipients. JAMA. 2021;325(21):2204-2206. doi:10.1001/jama.2021.7489

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