COVID-19 Prevention in Solid Organ Transplant Recipients: Current State of the Evidence

Maria Tsikala Vafea; Ghady Haidar

doi:10.1016/j.idc.2023.03.002

COVID-19 Prevention in Solid Organ Transplant Recipients: Current State of the Evidence

Infect Dis Clin North Am. 2023 Sep;37(3):459-473. doi: 10.1016/j.idc.2023.03.002. Epub 2023 Mar 22.

Authors

Maria Tsikala Vafea¹, Ghady Haidar²

Affiliations

¹ Divison of Internal Medicine, University of Pittsburgh School of Medicine, UPMC, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
² Division of Infectious Diseases, University of Pittsburgh School of Medicine, 3601 Fifth Avenue, Falk Medical Building, Suite 5B, Pittsburgh, PA 15213, USA. Electronic address: haidarg@upmc.edu.

Abstract

Although COVID-19 vaccines are safe, most organ transplant recipients fail to mount an antibody response after two mRNA vaccines. Thus, three mRNA vaccines constitute a primary vaccine series after solid organ transplant. However, neutralizing antibodies after three or greater mRNA vaccines are lower against Omicron versus older variants. Predictors of attenuated responses include age, vaccination within 1 year from transplant, mycophenolate, and BNT162b2. Some seronegative transplant recipients exhibit durable T-cell responses. Vaccine effectiveness in transplants is lower than in the general population. Immunosuppression reduction around revaccination warrants further study. Monoclonal antibody pre-exposure prophylaxis may be protective against susceptible variants.

Keywords: Antibody; COVID-19; SARS-CoV-2; Solid organ transplant; T-cell; mRNA vaccine.

Publication types

Review

MeSH terms

BNT162 Vaccine
COVID-19 Vaccines* / administration & dosage
COVID-19* / prevention & control
Humans
Organ Transplantation*
Transplant Recipients

Substances

BNT162 Vaccine
COVID-19 Vaccines