Immunosuppressant and SARS-CoV-2 Vaccine Antibody Response After Lung Transplantation

There are insufficient reports on the immunogenicity and safety of the COVID-19 vaccination after lung transplantation in Korea.

Between April and September 2021, lung transplant recipients (n = 52) and healthy controls (n = 22) underwent vaccination. The levels of antibodies were assessed prospectively at 4 weeks after priming and second dose.

Of a total of 52 lung transplant recipients, there were 84.6% nonresponders, 15.4% second-dose responders, and 0% primary dose responders. Among healthy controls, 63.6% were priming responders, and 18.2% were second-dose responders, and 18.2% were nonresponders. Compared with the control group, lung recipients were less likely to develop antibodies (P < .001). Antibody formation tended to be higher in recipients more than 1 year after transplantation (0 vs 20.5%, P = .076). No major safety events were reported, and the adverse symptoms were mild and consistent with those of the general population. In a multivariate regression analysis, mycophenolic acid levels (µg/mL) (odds ratio 0.25, P = .005) and tacrolimus level (ng/mL) (odds ratio 0.65, P = .035) were significantly associated with antibody formation.

The immunogenicity of the second dose of COVID-19 vaccination with various combinations was substantially low in lung transplants. A booster of the COVID-19 vaccine is warranted in lung transplants, especially a year later.