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Relationship Between Immune Response to Severe Acute Respiratory Syndrome Coronavirus 2 Vaccines and Development of Breakthrough Infection in Solid Organ Transplant Recipients: The CONTRAST Cohort.


ABSTRACT:

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in solid organ transplant (SOT) recipients is associated with poorer antibody response (AbR) compared with non-SOT recipients. However, its impact on the risk of breakthrough infection (BI) has yet to be assessed.

Methods

Single-center prospective longitudinal cohort study enrolling adult SOT recipients who received SARS-CoV-2 vaccination during a 1-year period (February 2021 - January 2022), end of follow-up April 2022. Patients were tested for AbR at multiple time points. The primary end-point was BI (laboratory-confirmed SARS-CoV-2 infection ≥14 days after the second dose). Immunization (positive AbR) was considered an intermediate state between vaccination and BI. Probabilities of being in vaccination, immunization, and BI states were obtained for each type of graft and vaccination sequence using multistate survival analysis. Then, multivariable logistic regression was performed to analyze the risk of BI related to AbR levels.

Results

614 SOT (275 kidney, 163 liver, 137 heart, 39 lung) recipients were included. Most patients (84.7%) received 3 vaccine doses. The first 2 consisted of BNT162b2 and mRNA-1273 in 73.5% and 26.5% of cases, respectively. For the third dose, mRNA-1273 was administered in 59.8% of patients. Overall, 75.4% of patients reached immunization and 18.4% developed BI. Heart transplant recipients showed the lowest probability of immunization (0.418) and the highest of BI (0.323); all mRNA-1273 vaccine sequences showed the highest probability of immunization (0.732) and the lowest of BI (0.098). Risk of BI was higher for non-high-level AbR, younger age, and shorter time from transplant.

Conclusions

SOT patients with non-high-level AbR and shorter time from transplantation and heart recipients are at highest risk of BI.

SUBMITTER: Bonazzetti C 

PROVIDER: S-EPMC10209432 | biostudies-literature | 2023 May

REPOSITORIES: biostudies-literature

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Publications

Relationship Between Immune Response to Severe Acute Respiratory Syndrome Coronavirus 2 Vaccines and Development of Breakthrough Infection in Solid Organ Transplant Recipients: The CONTRAST Cohort.

Bonazzetti Cecilia C   Tazza Beatrice B   Gibertoni Dino D   Pasquini Zeno Z   Caroccia Natascia N   Fanì Francesca F   Fornaro Giacomo G   Pascale Renato R   Rinaldi Matteo M   Miani Beatrice B   Gamberini Chiara C   Morelli Maria Cristina MC   Tamé Mariarosa M   Busutti Marco M   Comai Giorgia G   Potena Luciano L   Borgese Laura L   Salvaterra Elena E   Lazzarotto Tiziana T   Scudeller Luigia L   Viale Pierluigi P   Giannella Maddalena M  

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 20230501 10


<h4>Background</h4>Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in solid organ transplant (SOT) recipients is associated with poorer antibody response (AbR) compared with non-SOT recipients. However, its impact on the risk of breakthrough infection (BI) has yet to be assessed.<h4>Methods</h4>Single-center prospective longitudinal cohort study enrolling adult SOT recipients who received SARS-CoV-2 vaccination during a 1-year period (February 2021 - January 2022), end o  ...[more]

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