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Title: Clinical Course, Immunogenicity, and Efficacy of BNT162b2 mRNA Vaccination Against SARS-CoV-2 Infection in Liver Transplant Recipients
Authors: Tan, Eunice X
Lim, Wen Hui
Thong, Elizabeth
Chavatte, Jean-Marc
Zhang, Jinyan 
Lim, Jonathan
Jin, Jocelyn Y 
Lim, Daniel RX 
Kang, Jaclyn YT
Tang, Ansel Shao Pin
Chan, Kai En
Tan, Caitlyn
Tan, Shi Ni
Nah, Benjamin
Huang, Daniel Q 
Wang, Lin-Fa
Tambyah, Paul A 
Somani, Jyoti 
Young, Barnaby
Muthiah, Mark D 
Keywords: Science & Technology
Life Sciences & Biomedicine
Issue Date: Oct-2023
Citation: Tan, Eunice X, Lim, Wen Hui, Thong, Elizabeth, Chavatte, Jean-Marc, Zhang, Jinyan, Lim, Jonathan, Jin, Jocelyn Y, Lim, Daniel RX, Kang, Jaclyn YT, Tang, Ansel Shao Pin, Chan, Kai En, Tan, Caitlyn, Tan, Shi Ni, Nah, Benjamin, Huang, Daniel Q, Wang, Lin-Fa, Tambyah, Paul A, Somani, Jyoti, Young, Barnaby, Muthiah, Mark D (2023-10). Clinical Course, Immunogenicity, and Efficacy of BNT162b2 mRNA Vaccination Against SARS-CoV-2 Infection in Liver Transplant Recipients. TRANSPLANTATION DIRECT 9 (10). ScholarBank@NUS Repository.
Abstract: Immunocompromised individuals have been excluded from landmark studies of messenger RNA vaccinations for severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). In such patients, the response to vaccination may be blunted and may wane more quickly compared with immunocompetent patients. We studied the factors associated with decreased antibody response to SARS-CoV-2 vaccination and risk factors for subsequent breakthrough infections in liver transplant (LT) patients undergoing coronavirus disease 2019 vaccination with at least 2 doses of messenger RNA vaccine from April 28, 2021, to April 28, 2022. Methods. All LT recipients received at least 2 doses of the BNT162b2 (Pfizer BioNTech) vaccine 21 d apart. We measured the antibody response against the SARS-CoV-2 spike protein using the Roche Elecsys immunoassay to the receptor-binding domain of the SARS-CoV-2 spike protein, and the presence of neutralizing antibodies was measured by the surrogate virus neutralization test (cPass) before first and second doses of vaccination and also between 2 and 3 mo after the second dose of vaccination. Results. Ninety-three LT recipients who received 2 doses of BNT162b2 were included in the analysis. The mean time from LT was 110 ± 154 mo. After 2-dose vaccination, 38.7% of LT recipients (36/93) were vaccine nonresponders on the cPass assay compared with 20.4% (19/93) on the Roche S assay. On multivariable analysis, increased age and increased tacrolimus trough were found to be associated with poor neutralizing antibody response (P = 0.038 and 0.022, respectively). The use of antimetabolite therapy in conjunction with tacrolimus approached statistical significance (odds ratio 0.21; 95% confidence interval, 0.180-3.72; P = 0.062). Breakthrough infection occurred in 18 of 88 LT recipients (20.4%). Female gender was independently associated with breakthrough infections (P < 0.001). Conclusions. Among LT recipients, older age and higher tacrolimus trough levels were associated with poorer immune response to 2-dose SARS-CoV-2 vaccination. Further studies are needed to assess variables associated with breakthrough infections and, hence, who should be prioritized for booster vaccination.
ISSN: 2373-8731
DOI: 10.1097/TXD.0000000000001537
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