key: cord-0682615-tt3z51xq
authors: Singh, R.; Kutac, C.; Bourgeois, S.; Goss, J. A.; Civitello, A. B.; Stribling, R.; Timmins, K.; Murthy, B.; Baz, M.; Segraves, J.; Li, G.; Garcha, P.; Kumar, A.
title: Safety, Reactogenicity and Patient Perceptions of COVID-19 Vaccination in Solid Organ Transplant Recipients at a Quaternary Referral Center
date: 2022-04-30
journal: The Journal of Heart and Lung Transplantation
DOI: 10.1016/j.healun.2022.01.1337
sha: 9eb448d109d066ebee6f0b0d2c687e7c5c8d32ac
doc_id: 682615
cord_uid: tt3z51xq

Purpose Solid organ transplant recipients (SOTR) are at high-risk for poor health outcomes following COVID-19. Several studies have evaluated the antibody response to the vaccine amongst SOTR, yet there is a need to better understand peri-vaccination reactogenicity and patient behavior in SOTR. Our study reports the side effects, safety and the patient perceptions of the Pfizer vaccine amongst our center's SOTR. Methods In this single-center study, SOTR (heart, kidney, liver, lung, combined) who received the Pfizer (BNT162b2) vaccine in February-March 2021 completed an online survey about their side effects (SE) after the first and second dose of the vaccine, co-morbidities, masking behaviors, breakthrough infection, and perceptions regarding sense of protection and safety after vaccination. Descriptive and logistical regression analyses were performed. Results The survey was sent to 550 SOTR, of which 210 SOTR completed it thus far. Median age is 62 years, 154 (72%) are males and 61 (28 %) are females. 81 (39%) experienced SE after both doses. After dose one, 53% patients experienced a SE, the most common being injection site pain (79%). After dose two, 53% patients experienced a SE, including injection site pain (61%) followed by systemic SE (39%). No patient hospitalization after either dose was reported. Within a 6-month period post vaccination, only 1 patient tested positive for COVID-19 after the first dose. Increased age reduced the risk for SE for both first and second doses (0.95 (0.92-0.97, p<0.001 and 0.96 (0.94-0.99), p<0.002). SOTR without diabetes had a significant increase in injection site pain (1.92 (1.05-3.49),p=0.033). For masking behaviors, 83% plan to continue masking in healthcare settings while 10% will no longer mask in any setting. Regarding sense of worry of receiving the vaccine, 66% did not feel worried while 10% felt very worried. After vaccination, 53% felt very protected while 15% did not feel protected at all. Conclusion In SOTR who received the Pfizer vaccine, 39% of patients reported side effects after both doses. Injection site pain was most common after first dose and systemic side effects were more after the second dose. The study reinforces the safety profile of the vaccine and SOTR with reactogenicity similar to other studies. Even after vaccination, majority of SOTR plan to wear masks in various settings.

Methods: From February 1, 2021 to September 1, 2021, SARS-CoV-2 positivity, admissions to the hospital, and mortality among lung transplant recipients was recorded at our institution. This timeframe was selected as the mRNA vaccine became available to recipients of lung transplantation in February of 2021. To obtain the immunization status of lung transplant recipients eligible for vaccination with one of the two mRNA vaccines, a query of the electronic medical record was performed during the previously mentioned dates. Results: Among 317 patients, 276 had received at least two doses of mRNA vaccine (87%). Twenty-six tested positive (8.2%). Of the 26 individuals who developed COVID-19, 20 (76.9%) required admission to the hospital with eight deaths (30.8%). Four deaths occurred among the 13 individuals who contracted SARS-CoV-2 despite having received a minimum of two doses of mRNA vaccine representing a 30.7% mortality. The average duration between immunization and a positive PCR result was 86 days (SD 56 days) for individuals who had received at least two doses of a vaccine. Conclusion: Recent studies have shown that a third dose of the mRNA vaccine BNT162b2 (Pfizer-BioNTech) can augment the antibody response in solid organ transplantation recipients 4 . The immunogenicity of the mRNA vaccine in this population still remains less vigorous compared to the immunocompetent. The reduced efficacy of mRNA vaccines combined with the elevated rate of admission and mortality described above, demonstrate that vaccination alone cannot annul the impact of COVID-19 in these patients. When mask wearing, social distancing, and hand-washing fail, therapies such as casirivimab and imdevimab (REGN-COV2), neutralizing monoclonal antibodies against SARS-CoV-2 could be considered in early disease to suppress viral load 5 and protect this vulnerable population despite immunization status.

(1313)

Recipients: A Single Centre Study U. Shah, 1 V. Rahulan, 2 S. Ravipati, 2 S. Kumar, 2 A. Kamath, 2 S. Kori, 2 S. Panda, 2 P. Kumar, 2 P. John, 2 M. BN, 2 P. Dutta, 2 and S. Attawar. 2 1 Pulmonology, KIMS, Hyderabad, India; and the 2 KIMS, Hyderabad, India.

Purpose: Solid Organ Transplant recipients (SOT) are at higher risk of SARS-CoV-2 infection. Mortality rates reported between 13 to over 30% in SOT recipients. SARSÀCoVÀ2 vaccination may help reduce the morbidity and mortality of COVIDÀ19 among SOT. There is paucity of literature of SARS-CoV-2 vaccination efficacy in lung transplantation recipients . The purpose of the study was 1) to evaluate SARS-CoV-2 vaccination efficacy & safety in lung transplantation recipients and 2) to assess the need for 3 rd booster dose. The study also showed safety of SARS-CoV-2 vaccines in such immunocompromised subset. However, for those recipients with no vaccination efficacy, utility of 3 rd booster dose and at what interval needs more research. Purpose: The COVID-19 pandemic represents a major global health burden, and an important cause of morbidity and mortality nowadays. Data remains scarce on COVID-19 in lung transplant recipients (LTR). The purpose of this study was to understand impact of infection with COVID-19 in this population, to investigate different variables that contributed to the prognosis, and to assess the long-term clinical outcomes. This represents the largest cohort of continuously followed LTR with COVID-19 to date. Methods: We conducted an observational retrospective cohort study of LTRs infected with COVID 19 at a major transplant center between June 2020 and April 2021. Infection was defined by having a positive diagnostic polymerase chain reaction (PCR) test. Patients' characteristics, COVID severity and management were retrieved. Changes in individual patient's FEV1, imaging and trans-bronchial lung biopsies (TBLB) performed at 3, 6, and 12 month intervals after infection were compared to the baseline prior to infection. Results: Fifty-three LTRs were identified as having COVID infection. Median age was 64 years, 31 (58.5%) were males, and 48 (90.5%) were double-LTR. Average BMI was 26.71 and 9 patients had diabetes. 38 (71.7%) patients were on three immunosuppression agents, and 4 (7.5%) patients had an augmented immunosuppression prior to COVID infection. 7 (13.2%) patients had at least one dose of mRNA COVID vaccine. 29 (54.7%) patients were treated as outpatient. Among admitted patients, 13 (24.5%) were treated in the ICU, and 7 (13.2%) required mechanical ventilation. Mortality rate was 15.1%. 26 patients had follow up on their FEV1 in 3 months, 33 in 6 months, and 7 up to 12 months. 14 (26.4%) patients had at least >10% drop in their FEV1, of which 10 patients had >20% drop. 18 patients had TBLB in 3 months, 19 in 6 months, and 4 in 12 months. Overall, 7 (13.2%) patients had acute cellular rejections (ACR). 23 patients had chest imaging at time of infection, with CT scan available for 10. Out of these, 6 showed pure ground glass opacities (GGO), and 4 showed mixed GGO and nodular opacities. Conclusion: Out of our 53 LTR with COVID infection, 24.5% had severe disease. Mortality was high in our cohort at 15.1%. PFT decline was common, with 26.4% having an FEV1 drop of over 10% at follow up, suggesting persistent complications are common.

Short Term Outcomes of Patients Who Underwent Lung Transplant for COVID-19 ARDS S. Nandavaram, 1 V. Scheuble, 2 L. Benninger, 3 and S

Methods: This is a single-center retrospective cohort study of patients who underwent lung transplantation for COVID 19 ARDS between 7/1/2020 and 06/30/2021. Study was IRB-approved. Baseline demographic data, pre transplant variables, peri operative data and post transplant variables were extracted. Post-transplant graft function variables were followed until 09/30/2021. Results: Twenty patients underwent lung transplantation alone, and one patient underwent lung kidney transplantation