BACKGROUND
Previous studies have reported that lung transplant recipients (LTR) develop a poor response to two doses of COVID-19 vaccine, but data regarding the third dose are lacking. We investigated the antibody response after three doses of mRNA vaccine in LTR and its predictive factors.
METHODS
A total of 136 LTR, including 10 LTR previously infected and 126 COVID-19-naive LTR, were followed during and after three doses of mRNA vaccine. We retrospectively measured anti-receptor-binding domain (RBD) IgG response and neutralizing antibodies. In a posthoc analysis, we used a multivariate logistic regression model to assess the association between vaccine response and patient characteristics, including viral DNA load (VL) of the ubiquitous Torque teno virus (TTV) (optimal cut-off set by ROC curve analysis), which reflects the overall immunosuppression.
RESULTS
After 3 doses, 47/126 (37.3%) COVID-19-naive LTR had positive anti-RBD IgG (responders) and 14/126 (11.1%) had antibody titers above 264 Binding Antibody Units/mL. None neutralized the omicron variant versus 7 of the 10 previously infected LTR. Nonresponse was associated with TTV VL ≥6.2 log10 copies/mL before vaccination (Odds Ratio (OR) = 17.87, 95% confidence interval (CI95) = 3.02-105.72), mycophenolate treatment (OR = 4.73, CI95 = 1.46-15.34) and BNT162b2 (n = 34; vs mRNA-1273, n = 101) vaccine (OR = 6.72, CI95 = 1.75-25.92). In second dose non-responders, TTV VL ≥6.2 or <3.2 log10 copies/mL before the third dose was associated with low (0/19) and high (9/10) rates of seroconversion.
CONCLUSION
COVID-19-naive LTR respond poorly to three doses of mRNA vaccine, especially those with high TTV VL. Future studies could further evaluate this biomarker as a guide for vaccine strategies.
【저자키워드】 COVID-19 vaccine, Immunosuppression, vaccine response, torque teno virus, lung transplantation, 【초록키워드】 Treatment, Vaccine, vaccination, Biomarker, Neutralizing antibodies, mRNA vaccine, mRNA-1273, virus, BNT162b2, Seroconversion, Characteristics, RBD, non-responders, Patient, Antibody titer, Factors, Omicron variant, lung transplant, association, Analysis, dose, ROC Curve, Anti-RBD IgG, Predictive, IgG response, torque, 95% confidence interval, second dose, multivariate logistic regression, anti-receptor-binding domain, responders, doses, previous study, cut-off, positive, recipient, viral DNA, Future, neutralized, develop, evaluate, reported, investigated, reflect, the antibody response, Ratio, LTR, respond poorly, 【제목키워드】 COVID-19, Antibody Response, virus, DNA, lung transplant, marker, regimen, Predictive, torque, recipient, mRNA-based vaccine,