Three Month Antibody Durability and Kinetics in Sars-cov-2 Mrna Vaccinated Heart and Lung Transplant Recipients: Differences Above the Diaphragm
1Johns Hopkins, Baltimore, MD, 2University of Wisconsin, Madison, WI
Meeting: 2022 American Transplant Congress
Abstract number: 968
Keywords: Antibodies, COVID-19, Vaccination
Topic: Clinical Science » Infection Disease » 24 - All Infections (Excluding Kidney & Viral Hepatitis)
Session Information
Session Name: All Infections (Excluding Kidney & Viral Hepatitis) II
Session Type: Poster Abstract
Date: Sunday, June 5, 2022
Session Time: 7:00pm-8:00pm
Presentation Time: 7:00pm-8:00pm
Location: Hynes Halls C & D
*Purpose: Heart and lung transplant (HT/LT) recipients have impaired humoral responses to SARS-CoV-2 vaccination compared to other solid organ transplant recipients (SOTRs). The purpose of this study is to describe antibody titer kinetics and durability among HT and LT recipients.
*Methods: HT or LT recipients (> 18 years) with no known COVID-19 infection were included. Demographics and clinical characteristics were collected via survey. Serologic testing was performed on the Roche Elecsys anti-SARS-CoV-2 enzyme immuno-assay (EIA) or the EUROIMMUN EIA pre- and post-dose 2 (D2).
*Results: Among 93 HT recipients, 59 (63%) were seropositive 1 month and 66 (71%) 3 months post-D2 (Table 1). Seropositive HT recipients had a higher median length of time from transplant to vaccination. 7/66 (11%) had delayed seroconversion (were negative for antibodies 1-month post-D2). Median(IQR) anti-RBD was 81 (8, 250) 1-month post-D2 (n=38) and 231 (48, 438) U/mL 3-months post-D2 (n=43) (Figure 1). Among 68 LT recipients, 29/68 (43%) were seropositive 1-month and 30 (44%) 3-months post-D2. Seronegative LT recipients were more likely to younger (18-39 years old, 15% vs 3%), or older (> 60 years, 74% vs. 50%, p=0.01). Seronegative LT recipients were more likely to be on anti-metabolite therapy (79% vs. 53%, p=0.04) and had a lower median length of time from transplant to vaccination. Among seropositive LT recipients at 3-months, 3 (10%) had delayed seroconversion. Median (IQR) anti-RBD was 61 (4, 233) U/mL 1-month post-D2 (n=26) and 45(11, 299) U/mL 3-months post-D2.
*Conclusions: HT and LT recipients develop a delayed and variable antibody response to mRNA SARS-CoV-2 vaccination. HT recipients more frequently seroconverted, and had higher anti-RBD levels, than LT recipients. Persistent negative and low antibody titers may place LT recipients at the highest risk of breakthrough SARS-CoV-2 infection among SOTRs.
| Characteristic | Heart Negative At 3 Months |
HeartPositive at 3 Months | p-value | LungNegative at 3 Months | LungPositive at 3 Months | p-value |
| Age (median, IQR) y | 61 (39-69) | 58 (44-68) | 0.95 | 66 (55-72) | 63 (53-71) | 0.79 |
| Years Since Transplant (median, IQR) | 3.9 (1.7-6.2) | 9.3 (4.3-14.4) | 0.002 | 3.8 (1.8-8.3) | 5.5 (4.6-10.7) | 0.04 |
| Anti-metabolite, n (%) | 20 (74) | 38 (58) | 0.16 | 30 (79) | 16 (53) | 0.04 |
| 1 Month Antibody Positive, n (%) | 1 (4) | 59 (89) | <0.001 | 2 (5) | 27 (90) | <0.001 |
| 1 Month Antibody Negative, n (%) | 26 (96) | 7 (11) | 36 (95) | 3 (10) | ||
| Vaccine: BNT162b2, n (%) | 17 (63) | 34 (52) | 0.36 | 23 (60) | 12 (40) | 0.14 |
| Vaccine: mRNA-1273, n (%) | 10 (37) | 32 (48) | 15 (40) | 18 (60) |
To cite this abstract in AMA style:
Alejo JL, Ruck J, Chiang T, Abedon A, Kim J, Avery R, Tobian A, Levan M, Warren D, Massie A, Werbel W, Garonzik-Wang J, Segev D. Three Month Antibody Durability and Kinetics in Sars-cov-2 Mrna Vaccinated Heart and Lung Transplant Recipients: Differences Above the Diaphragm [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/three-month-antibody-durability-and-kinetics-in-sars-cov-2-mrna-vaccinated-heart-and-lung-transplant-recipients-differences-above-the-diaphragm/. Accessed May 18, 2025.« Back to 2022 American Transplant Congress