Researchers recently reported that among solid organ transplant patients who had a suboptimal antibody reaction to standard COVID-19 vaccine and were given a third dose, some had an increase in response, while others did not.
In a case series from Johns Hopkins Medical Institutions, a Renal & Urology News report specified, 30 patients with a median age of 57 years, 17 women and one non-White were given a third dose of COVID-19 vaccine at a median of 75 days following receipt and standard two doses of a COVID-19 mRNA vaccine, either a Moderna or Pfizer-BioNTech vaccine, and exhibiting no or low antibody response in 24 and six patients, respectively.
Only six patients were given the third dose of the same vaccine. The rest got the substitute mRNA vaccine or the Johnson & Johnson/Janssen viral vector vaccine. As a result, none of the organ transplant patients had previous COVID-19 infection.
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This new study is the first to record the use of the third dose of a COVID-19 vaccine in solid organ transplant patients.
Antibody Titers
The six patients who had low-positive antibody titers before getting their third dose had high-positive antibody titers after receiving their third dose, reported William Werbel, MD, and colleagues from the Johns Hopkins Medical Institute in Baltimore, Maryland.
Meanwhile, from the 24 patients who had negative antibody titers prior to their third dose, six or 25 percent exhibited high positive antibody titers after their third dose, two or eight percent had low-positive antibody titers, and 16 or 67 percent remained negative.
Describing findings of their study, Safety, and Immunogenicity of a Third Dose of SARS-CoV-2 Vaccine in Solid Organ Transplant Recipients: A Case Series, published in the journal, Annals of Internal Medicine, the authors said antibody titers increased after the third dose in one-third of organ transplant patients with previously negative antibody titers, as well as in all patients who had previously low-positive antibody titers "is encouraging."
Dr. Werbel suggested, for people who do not develop antibody reactions to a third COVID-19 vaccine dose, consider substitute vaccine regimens like "adjuvanted vaccines, passive immunization with a long-acting monoclonal antibody," or controlling immunosuppressive drugs if the danger for organ rejection is low, concert with the provider of transplant and, or in the context of a clinical test.
Adjuvant, according to the Centers for Disease Control and Prevention, is an ingredient used in some vaccines, helping to develop a stronger immune reaction in people getting the vaccine.
At this time, it is unclear if one vaccine procedure is superior to another, explained Dr. Werbel. He noted that transplant patients might opt not to pursue added interventions and stay vigilant in the prevention of contagions.
Link to Poor Reaction to a 2-Dose mRNA Series
The median time between the initial vaccination and transplantation was 4.5 years. More so, of the 30 solid organ transplants, 23 of them were two pancreas, two heart, one lung, and three liver transplants, including one kidney-pancreas.
In addition, in 25 patients, maintenance immunosuppression comprised tacrolimus or cyclosporine plus mycophenolate.
Additionally, 24 patients were given corticosteroids. One received sirolimus, and another patient got belatacept. Dr. Werbel explained, they were not able to identify associations between immunosuppressive medicines and antibody response to third doses because of the small number of patients in this research.
Their prior work specified, though, he added, that belatacept and mycophenolate are linked to a poor reaction to a two-dose mRNA series.
Organ Transplant Patients' Reaction to COVID-19
Regarding reactions to the COVID-19 vaccine, the most frequent systemic reaction was moderate or mild fatigue in 14 participants, severe headache in one, and severe myalgia in one patient. None of the patients had a fever, anaphylactoid reactions, or neurologic problems.
One recipient of heart transplant had biopsy-proven, antibody-mediated rejection seven days following her third dose, in the setting of acute volume overload, although her heart function stayed normal.
The said patient did not have an increased COVID-19 antibody response. Her immunosuppression procedure was not strengthened. The research team noted that none of the patients developed COVID-19 during the short-period follow-up.
As far as the researchers are aware, their work is the first to record the use of the third dose of a COVID-19 vaccine in solid organ transplant patients.
Related information is shown on Northwell Health's YouTube video below:
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