Effect of Covid-19 Vaccination on Markers of Rejection in Heart Transplant Recipients

Z. Pieters¹, E. Bruno¹, S. Kim¹, S. De Sirkar¹, M. Thomas¹, S. B. Sharmin², M. Liebo¹, A. Heroux¹, N. Clark¹, G. Reid¹, S. Uprichard², M. Yu¹

¹Medicine, Loyola University Medical Center, Maywood, IL, ²Loyola University Chicago, Chicago, IL

Meeting: 2022 American Transplant Congress

Abstract number: 140

Keywords: COVID-19, Heart transplant patients, Rejection, Vaccination

Topic: Clinical Science » Heart » 63 - Heart and VADs: All Topics

Session Information

Session Name: Heart and VADs: All Topics I

Session Type: Rapid Fire Oral Abstract

Date: Sunday, June 5, 2022

Session Time: 5:30pm-7:00pm

Presentation Time: 5:30pm-5:40pm

Location: Hynes Room 210

*Purpose: Heart transplant recipients have worse survival with COVID-19 than the general population, highlighting the importance of vaccination in these patients. The impact of vaccination on rejection in transplant recipients is not well studied. This study examines the association of vaccination for COVID-19 with changes in markers for and evidence of transplant rejection.

*Methods: A retrospective analysis of heart transplant recipients vaccinated for COVID-19 was conducted at a major tertiary care center in the American Midwest. Serial antibody responses were drawn after vaccination to assess vaccine response. Data from routine transplant surveillance was extracted from the electronic medical record. Markers of rejection included Allomap, Allosure, donor specific antibodies (DSA), and endomyocardial biopsies. Only patients with comparative data within 365 days of their first COVID-19 vaccination were included for analysis. Numerical data was assessed using descriptive statistics. Categorical variables were analyzed using Fisher’s exact tests.

*Results: Between January 1, 2021 and September 30, 2021, 51 heart transplant recipients had COVID-19 antibody levels checked post-vaccination. There was an increase in the mean Allomap (31.19 ± 5.27 vs 32.14 ± 4.30), Allosure (0.04 ± 0.08 vs 0.11 ± 0.12%), and biopsy C4d% (3.33 ± 8.16 vs 10.00 ± 12.65%) levels post-vaccination compared to those pre-vaccination. Both positive and negative responders to vaccination showed this numerical increase in markers of rejection. There was no change in biopsy grades for acute cellular rejection, nor any changes in class I DSA positivity. One patient who had a positive antibody response to the vaccine had a de novo class II DSA post vaccination. No patients in this cohort had an episode of treated rejection post vaccination.

*Conclusions: Heart transplant recipients receiving COVID-19 vaccination have numerical increases in markers of rejection like Allomap, Allosure, and biopsy C4d%. These subtle changes may suggest a difference in the immunologic environment but are of unclear significance. There was no change in biopsy proven ACR or treated episodes of rejection. Further studies are warranted to investigate the effect of COVID-19 vaccination on transplant rejection.

To cite this abstract in AMA style:

Pieters Z, Bruno E, Kim S, Sirkar SDe, Thomas M, Sharmin SB, Liebo M, Heroux A, Clark N, Reid G, Uprichard S, Yu M. Effect of Covid-19 Vaccination on Markers of Rejection in Heart Transplant Recipients [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/effect-of-covid-19-vaccination-on-markers-of-rejection-in-heart-transplant-recipients/. Accessed May 18, 2025.

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