The Lancet Regional Health. Americas (Dec 2022)

SARS-CoV-2 vaccine booster in solid organ transplant recipients previously immunised with inactivated versus mRNA vaccines: A prospective cohort study

  • Martín Dib,
  • Nicole Le Corre,
  • Catalina Ortiz,
  • Daniel García,
  • Marcela Ferrés,
  • Constanza Martinez-Valdebenito,
  • Cinthya Ruiz-Tagle,
  • María José Ojeda,
  • Manuel A. Espinoza,
  • Aquiles Jara,
  • Juan Pablo Arab,
  • Ricardo Rabagliati,
  • Cecilia Vizcaya,
  • María Elena Ceballos,
  • Mauricio Sarmiento,
  • Sebastián Mondaca,
  • Macarena Viñuela,
  • Antonia Pastore,
  • Vania Szwarcfiter,
  • Elizabeth Galdames,
  • Aldo Barrera,
  • Pablo Castro,
  • Nicolás MS Gálvez,
  • Jorge A. Soto,
  • Susan M. Bueno,
  • Alexis M. Kalergis,
  • Bruno Nervi,
  • M. Elvira Balcells

Journal volume & issue
Vol. 16
p. 100371

Abstract

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Summary: Background: Solid-organ transplant (SOT) recipients have worse COVID-19 outcomes than general population and effective immunisation in these patients is essential but more difficult to reach. We aimed to determine the immunogenicity of an mRNA SARS-CoV-2 vaccine booster in SOT recipients previously immunised with either inactivated or homologous SARS-CoV-2 mRNA vaccine. Methods: Prospective cohort study of SOT recipients under medical care at Red de Salud UC-CHRISTUS, Chile, previously vaccinated with either CoronaVac or BNT162b2. All participants received a BNT162b2 vaccine booster. The primary study end point was anti-SARS-CoV-2 total IgG antibodies (TAb) seropositivity at 8-12 weeks (56-84 days) post booster. Secondary end points included neutralising antibodies (NAb) and specific T-cell responses. Findings: A total of 140 (50% kidney, 38% liver, 6% heart) SOT recipients (mean age 54 [13.6] years; 64 [46%] women) were included. Of them, 62 had homologous (three doses of BNT162b2) and 78 heterologous vaccine schedules (two doses of CoronaVac followed by BNT162b2 booster). Boosters were received at a median of 21.3 weeks after primary vaccination. The proportion achieving TAb seropositivity (82.3% vs 65.4%, P = 0.035) and NAb positivity (77.4% vs 55.1%, P = 0.007) were higher for the homologous versus the heterologous group. On the other hand, the number of IFN-γ and IL-2 secreting SARS-CoV-2-specific T-cells did not differ significantly between groups. Interpretation: This cohort study shows that homologous mRNA vaccine priming plus boosting in SOT recipients, reaches a significantly higher humoral immune response than inactivated SARS-CoV-2 vaccine priming followed by heterologous mRNA booster. Funding: School of Medicine, UC-Chile and ANID.ClinicalTrials.gov ID: NCT05124509

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