Lack of immune response after mRNA vaccination to SARS-CoV-2 in a solid organ transplant patient

The recent approval and distribution of vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been a major development in the fight against the current coronavirus disease 2019 (COVID-19) pandemic. The first two vaccines approved in the United States, mRNA-1273, and BNT162b2, are both messenger RNA (mRNA) based and highly effective in immunocompetent persons, but efficacy in patients on immunosuppressants has not been established. Additionally, data suggests these patients are less likely than immunocompetent people to develop neutralizing antibodies after COVID-19 infection. Given the high risk of poor outcomes in organ transplant and immunosuppressed patients, effective vaccination is paramount in this group. We present the first reported case of a solid organ transplant patient who failed to achieve seroconversion after two doses of mRNA vaccine. This case has significant implications about how immunosuppressed patients should be counseled about SARS-CoV-2 vaccination and the protection provided. Physicians should remain clinically suspicious for infection with SARS-CoV-2 despite vaccination status in solid organ transplant patients.