key: cord-0697909-s6n3l3rc
authors: Alejo, Jennifer L.; Mitchell, Jonathan; Chiang, Teresa Po-Yu; Abedon, Aura Toma; Sidoti, Carolyn N.; Boyarsky, Brian J.; Avery, Robin K.; Tobian, Aaron A.R.; Levan, Macey L.; Warren, Daniel S.; Massie, Allan B.; Garonzik-Wang, Jacqueline M.; Segev, Dorry Lidor; Werbel, William A.
title: Six-month Antibody Kinetics and Durability in SARS-CoV-2 mRNA Vaccinated Solid Organ Transplant Recipients
date: 2021-10-26
journal: Transplantation
DOI: 10.1097/tp.0000000000003975
sha: 2cde61417f7f9ff727c9b3e29ad426a3fed3180a
doc_id: 697909
cord_uid: s6n3l3rc

nan

W e previously reported the overall stability of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antispike antibodies in vaccinated solid organ transplant recipients (SOTRs) 3 mo after receiving 2 doses of BNT162b2 or mRNA-1237 vaccines. 1 In the interim, the US Food and Drug Administration fully authorized the BNT162b2 vaccine for people 16 y and older and expanded Emergency Use Authorization to allow for a third dose in immunocompromised individuals. 2 The Centers for Disease Control and Prevention currently recommends an additional dose for mild to moderately immunocompromised patients at least 28 d following mRNA dose 2, but optimal timing for booster doses in SOTRs has not been determined. 3 Declines in SARS-CoV-2 antibodies over time were observed 3 mo postvaccination in the general population, 4 but antibody longevity in SOTRs is unknown. Semiquantitative antispike antibody testing was performed using the Roche Elecsys (R) anti-SARS-CoV-2 S or the EUROIMMUN IgG enzyme immunoassays 1, 3, and 6 mo after dose 2. Participants provided informed consent, and this study was approved by the Johns Hopkins Institutional Review Board (IRB00248540).

Three hundred twelve SOTRs received a second mRNA vaccine between January 6, 2021, and April 14, 2021.

None reported a third dose during the study period. Median (interquartile range) age was 62 (48-69) y, 65% were female, and 92% were White. One hundred fifty-six (50%) were kidney transplant recipients, and median time from transplant was 7. Table 1 ). The 4 patients whose titers fell from high positive to negative experienced this by 3 mo.

In this study of SARS-CoV-2 antibody kinetics and durability, 73% of SOTRs had positive antibody titers 6 mo following mRNA vaccination; titers increased in 27% over 6 mo, decreased in 12%, and remained stable in 61% of patients over 6 mo. This differs from healthy individuals, who had overall stability of antibody positivity over 6 mo. 5 It is unknown what degree of antibody titer decline confers increased risk of breakthrough infection.

This study is limited by the lack of an immunocompetent control group, the unknown correlation with neutralizing antibody, and the absence of antinucleocapsid testing, prohibiting analysis of asymptomatic exposure. The presence of coronavirus disease 2019 infection would likely increase antibody levels.

In conclusion, antispike antibody levels against SARS-CoV-2 in SOTRs are relatively stable 6 mo after receipt of the second vaccine. Further investigation into the effect of booster vaccination on antibody titers, as well as understanding B-and T-cell responses against emerging variants of concern, is needed to better inform timing of booster vaccination. 

Antibody kinetics and durability in SARS-CoV-2 mRNA vaccinated solid organ transplant recipients

COVID-19) update: FDA authorizes additional vaccine dose for certain immunocompromised individuals

Division of Diseases. COVID-19 vaccines for moderately to severely immunocompromised people

mRNA-1273 Study Group. Durability of responses after SARS-CoV-2 mRNA-1273 vaccination

Antibody persistence through 6 months after the second dose of mRNA-1273 vaccine for COVID-19