Special Issue "SARS-CoV-2 Vaccination in Transplant Recipients"

A special issue of Vaccines (ISSN 2076-393X). This special issue belongs to the section "Innate and Adaptive Immunity in Vaccination".

Deadline for manuscript submissions: closed (30 November 2023) | Viewed by 2496

Special Issue Editors

Johns Hopkins School of Medicine, Baltimore, MD, USA
Interests: SARS-CoV-2; COVID-19; vaccines; antibody response
Medical Director, Comprehensive Transplant Center, The Johns Hopkins Hospital, Baltimore, MD, USA
Interests: SARS-CoV-2; COVID-19; vaccines; antibody response

Special Issue Information

Dear Colleagues,

Recipients of solid organ transplants are at a high risk of developing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated complications. The introduction of targeted vaccines has mitigated the risk of developing infection, albeit with a continued suboptimal response in comparison to the general population. This suboptimal response is mostly attributable to the use of maintenance immunosuppression to prevent organ rejection. This issue will cover the following pertinent aspects of the SARS-CoV-2 vaccine in recipients of solid organ transplantation: 

  1. Track the arc of development of the SARS-CoV-2 vaccines and their use in recipients of solid organ transplants;
  2. Review vaccine response in transplant recipients focused on each type of solid organ transplantation;
  3. Methods of monitoring immune response to vaccines;
  4. Measures to reduce the risk of infection in patients with an absent/reduced response to vaccines.

Dr. Sam Kant
Prof. Dr. Daniel Brennan
Guest Editors

Manuscript Submission Information

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Keywords

  • SARS-CoV-2
  • COVID-19
  • vaccines
  • antibody response

Published Papers (3 papers)

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Research

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12 pages, 1678 KiB  
Article
Successful SARS-CoV-2 mRNA Vaccination Program in Allogeneic Hematopoietic Stem Cell Transplant Recipients—A Retrospective Single-Center Analysis
Vaccines 2023, 11(10), 1534; https://doi.org/10.3390/vaccines11101534 - 28 Sep 2023
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Abstract
(1) Background: mRNA COVID-19 vaccines are effective but show varied efficacy in immunocompromised patients, including allogeneic hematopoietic stem cell transplant (HSCT) recipients. (2) Methods: A retrospective study on 167 HSCT recipients assessed humoral response to two mRNA vaccine doses, using the manufacturer cut-off [...] Read more.
(1) Background: mRNA COVID-19 vaccines are effective but show varied efficacy in immunocompromised patients, including allogeneic hematopoietic stem cell transplant (HSCT) recipients. (2) Methods: A retrospective study on 167 HSCT recipients assessed humoral response to two mRNA vaccine doses, using the manufacturer cut-off of ≥7.1 BAU/mL, and examined factors affecting non-response. (3) Results: Twenty-two percent of HSCT recipients failed humoral response. Non-responders received the first vaccine a median of 10.2 (2.5–88.9) months post-HSCT versus 35.3 (3.0–215.0) months for responders (p < 0.001). Higher CD19 (B cell) counts favored vaccination response (adjusted odds ratio (aOR) 3.3 per 100 B-cells/microliters, p < 0.001), while ongoing mycophenolate mofetil (MMF) immunosuppression hindered it (aOR 0.04, p < 0.001). By multivariable analysis, the time from transplant to first vaccine did not remain a significant risk factor. A total of 92% of non-responders received a third mRNA dose, achieving additional 77% seroconversion. Non-converters mostly received a fourth dose, with an additional 50% success. Overall, a cumulative seroconversion rate of 93% was achieved after up to four doses. (4) Conclusion: mRNA vaccines are promising for HSCT recipients as early as 3 months post-HSCT. A majority seroconverted after four doses. MMF usage and low B cell counts are risk factors for non-response. Full article
(This article belongs to the Special Issue SARS-CoV-2 Vaccination in Transplant Recipients)
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11 pages, 235 KiB  
Article
Disease Course, Management and Outcomes in Kidney Transplant Recipients with SARS-CoV-2 Infection during the Omicron-Variant Wave: A Single-Center Experience
Vaccines 2023, 11(3), 632; https://doi.org/10.3390/vaccines11030632 - 12 Mar 2023
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Abstract
Background: Since December 2019, kidney transplant recipients (KTRs) have experienced a great impact of the coronavirus disease 2019 (COVID-19) pandemic, with a higher risk of morbidity and mortality compared to the general population. Preliminary data in KTRs suggest that the Omicron variant, which [...] Read more.
Background: Since December 2019, kidney transplant recipients (KTRs) have experienced a great impact of the coronavirus disease 2019 (COVID-19) pandemic, with a higher risk of morbidity and mortality compared to the general population. Preliminary data in KTRs suggest that the Omicron variant, which has been dominant since December 2021, is more infectious than the previous ones but is associated with reduced risk of severity and low lethality rates. The purpose of our study was to assess the disease course and outcomes of the SARS-CoV-2 infection in KTRs during the Omicron-surge. Methods: This retrospective study included 451 KTRs diagnosed with SARS-CoV-2 infection between 1 December 2021 and 30 September 2022. Demographic and clinical characteristics at the time of infection, vaccination data, treatment, clinical course, and outcomes were recorded and analyzed. Results: Mean age was 51.8 ± 13.7 years with a male predominance (61.2%). The majority (76.1%) were vaccinated with at least three doses of the available mRNA vaccines, although serology revealed low anti-SARS-CoV-2 antibody titers before infection (33 [3.3–1205] AU/mL). Only 6% of the patients experienced moderate–severe disease. Accordingly, there was low prevalence of adverse outcomes, such as SARS-CoV-2-related hospitalization (11.3%) and death (0.9%). Multivariate analysis revealed that only age significantly increased the risk of SARS-CoV-2-related hospitalization. Conclusions: During the Omicron wave, the clinical course of the SARS-CoV-2 infection in KTRs has substantially changed, with lower rates of moderate and severe disease and a low prevalence of adverse outcomes. Prospective clinical trials are warranted to further elucidate the evolving pathogenesis, management, and long-term outcomes of COVID-19 in such high-risk populations. Full article
(This article belongs to the Special Issue SARS-CoV-2 Vaccination in Transplant Recipients)

Review

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19 pages, 1695 KiB  
Review
Measures to Increase Immunogenicity of SARS-CoV-2 Vaccines in Solid Organ Transplant Recipients: A Narrative Review
Vaccines 2023, 11(12), 1755; https://doi.org/10.3390/vaccines11121755 - 25 Nov 2023
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Abstract
Purpose of review: To review the data on the immunogenicity of COVID-19 vaccines, administered by different strategies, in solid organ transplant recipients (SOTRs). Recent findings: COVID-19 booster vaccines were given to SOTRs as a widespread practice in many transplant centers, mostly as [...] Read more.
Purpose of review: To review the data on the immunogenicity of COVID-19 vaccines, administered by different strategies, in solid organ transplant recipients (SOTRs). Recent findings: COVID-19 booster vaccines were given to SOTRs as a widespread practice in many transplant centers, mostly as the third and/or fourth dose in an extended vaccine series, with a significantly improved humoral response compared with the initial two-dose scheme. However, one-third of SOTRs remained unresponsive, despite these boosters. Next steps: Vaccination with standard dosing remains the most feasible strategy for attaining protection against COVID-19. Additional booster doses and temporarily holding or reducing mycophenolate mofetil/mycophenolic acid may provide immunogenicity to vaccines, according to recent studies demonstrating some efficacy with these measures. Preexposure prophylaxis with monoclonal antibodies showed benefit in immunocompromised patients but is no longer recommended by the National Institutes of Health (NIH) due to diminished efficacy against Omicron and recent variants. Screening for the presence and titers of SARS-CoV-2-specific antibodies in SOTRs is not recommended in most clinical settings. T cell-based techniques are needed to evaluate vaccine efficacy and risk of infection. As SARS-CoV-2 continues to evolve, new vaccines based on conservative protein component/complexes of the COVID virus, in addition to its spike protein, are warranted to offer prolonged protection. Full article
(This article belongs to the Special Issue SARS-CoV-2 Vaccination in Transplant Recipients)
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