• 1.

    Eckerle I, et al. Serologic vaccination response after solid organ transplantation: A systematic review. PLoS One 2013; 8:e56974. doi: 10.1371/journal.pone.0056974

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    • Export Citation
  • 2.

    Boyarsky BJ, et al. Antibody response to 2-dose SARS-CoV-2 mRNA vaccine series in solid organ transplant recipients. JAMA 2021; 325:22042206. doi: 10.1001/jama.2021.7489

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Nair V, et al. An early experience on the effect of solid organ transplant status on hospitalized COVID-19 patients. Am J Transplant 2021; 21:25222531. doi: 10.1111/ajt.16460

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Hall VG, et al. Randomized trial of a third dose of mRNA-1273 vaccine in transplant recipients. N Engl J Med [published online ahead of print August 11, 2021]. doi: 10.1056/NEJMc2111462; https://www.nejm.org/doi/10.1056/NEJMc2111462

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    • Export Citation
  • 5.

    Kamar N, et al. Three doses of an mRNA Covid-19 vaccine in solid-organ transplant recipients. N Engl J Med 2021; 385:661662. doi: 10.1056/NEJMc2108861

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Werbel WA, et al. Safety and immunogenicity of a third dose of SARS-CoV-2 vaccine in solid organ transplant recipients: A case series. Ann Intern Med [published online ahead of print June 15, 2021]. doi: 10.7326/L21-0282; https://www.acp-journals.org/doi/10.7326/L21-0282

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SARS-CoV-2 Vaccinations in Transplant Recipients: The More the Better?

  • 1 Vinay Nair, DO, is Associate Professor of Medicine and Medical Director of Kidney Transplantation, and Mersema Abate, MD, is Associate Professor of Medicine, Division of Kidney Disease and Hyper-tension, Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell, Hempstead, NY.
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Routine administration of inactivated, age-appropriate vaccines is recommended for organ transplant recipients. As with response to other vaccinations (1), antibody response to SARS-CoV-2 vaccine is diminished in transplant recipients (2). Moreover, these individuals face worse outcomes following COVID-19 infection (3).

A Correspondence in the New England Journal of Medicine by Hall et al. found a booster dose of mRNA-1273 vaccine 2 months after the standard 2-dose series improved both antibody and T-cell immunity to SARS-CoV-2 in organ transplant recipients (4). At month 4, patients who received three doses of vaccine had a threefold increase in positive antibody response, higher viral neutralization, and SARS-CoV-2-specific T-cells. Two retrospective studies from France (5) and the US (6) demonstrate similar findings (Table 1), and an NIH-funded study (clinicaltrials.gov NCT04C969263) is underway. Subsequently, the FDA authorized booster mRNA vaccination for transplant recipients. Although a major milestone, there are several questions that need to be answered: What antibody titer is required to prevent COVID-19? How do neutralizing antibodies translate to the more commonly available spike protein antibody assay? How effective is cellular immunity in the prevention of COVID-19? If antibody response improves after each subsequent dose, should nonresponders be given a fourth dose?

tbl1

As transplant nephrologists, it is our duty to protect our patients from severe illness associated with COVID-19. The manuscript by Hall et al. (4) is a step toward this goal. However, larger studies are still needed that will look at hard endpoints, such as hospitalization and mortality due to COVID-19.

References

  • 1.

    Eckerle I, et al. Serologic vaccination response after solid organ transplantation: A systematic review. PLoS One 2013; 8:e56974. doi: 10.1371/journal.pone.0056974

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Boyarsky BJ, et al. Antibody response to 2-dose SARS-CoV-2 mRNA vaccine series in solid organ transplant recipients. JAMA 2021; 325:22042206. doi: 10.1001/jama.2021.7489

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Nair V, et al. An early experience on the effect of solid organ transplant status on hospitalized COVID-19 patients. Am J Transplant 2021; 21:25222531. doi: 10.1111/ajt.16460

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Hall VG, et al. Randomized trial of a third dose of mRNA-1273 vaccine in transplant recipients. N Engl J Med [published online ahead of print August 11, 2021]. doi: 10.1056/NEJMc2111462; https://www.nejm.org/doi/10.1056/NEJMc2111462

    • Search Google Scholar
    • Export Citation
  • 5.

    Kamar N, et al. Three doses of an mRNA Covid-19 vaccine in solid-organ transplant recipients. N Engl J Med 2021; 385:661662. doi: 10.1056/NEJMc2108861

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Werbel WA, et al. Safety and immunogenicity of a third dose of SARS-CoV-2 vaccine in solid organ transplant recipients: A case series. Ann Intern Med [published online ahead of print June 15, 2021]. doi: 10.7326/L21-0282; https://www.acp-journals.org/doi/10.7326/L21-0282

    • Search Google Scholar
    • Export Citation
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