Improved immunogenicity following the third dose of BNT162b2 mRNA vaccine in heart transplant recipients. (4th March 2022)

• Record Type: Journal Article
• Authors: Shaul, Aviv Avraham; Itzhaki Ben Zadok, Osnat; Ben-Avraham, Binyamin; Yaari, Vicky; Barsheshet, Alon; Levi, Amos; Ben Zvi, Haim; Eliakim Raz, Noa; Abed, Galia; Abuhazira, Miriam; Abu Akel, Mahmood; Mats, Israel; Barac, Yaron D; Aravot, Dan; Kornowski, Ran; Ben-Gal, Tuvia
• Is Part Of: European journal of cardio-thoracic surgery. Volume 62:Number 4(2022)
• Publication Date: 2022-03-04
• Subjects: Severe acute respiratory syndrome coronavirus 2 -- COVID-19 -- Heart transplantation -- BNT162b2 vaccine -- Third dose; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezac145
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: OBJECTIVES: The immunogenicity of two-dose severe acute respiratory syndrome coronavirus 2 vaccine is lower among heart transplant (HTx) recipients, compared with the general population. Our aim was to assess the immunogenicity of a third-dose vaccine in HTx recipients. METHODS: This is a prospective cohort study of HTx recipients who received a third dose of the BNT162b2 vaccine. Immunogenicity was assessed by serum levels of anti-spike immunoglobulin G (S-IgG), taken at baseline and 14–28 days after the third dose. Titres above 50 U/ml were interpreted positive. RESULTS: We Included 42 HTx recipients at a median age of 65 years [interquartile range (IQR) 58–70]. At baseline, the median of 27 days (IQR 13–42) before the third dose and the median titre of the whole group was 18 U/ml (IQR 4–130). Only 14 patients (33%) were S-IgG seropositive. After the third dose, the proportion of seropositive patients increased significantly to 57% ( P = 0.05) and the median titre increased significantly to 633 U/ml (IQR 7–6104, P < 0.0001). Younger age at HTx (OR per 1-year decrease 1.07, P = 0.05), low tacrolimus serum level (OR per 1-unit decrease 2.28, P = 0.02), mammalian target of rapamycin use (OR 13.3, P = 0.003), lack of oral steroids use (OR 4.17, P = 0.04) and lack of calcineurin inhibitor use (71% of responders vs 100% non-responders received calcineurin inhibitors, P = 0.01) were predictors of seropositive result after the third dose. However, no significant association was detected following adjustment for baseline S-IgG titre. CONCLUSIONS: Third-dose booster of BNT162b2 vaccine significantly increased immunogenicity among HTx recipients who previously received a two-dose vaccine. Abstract : Heart transplant (HTx) recipients, as other solid organ transplant recipients, are at increased risk for poor outcome following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection [1, 2].