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Decline in antibody concentration 6 months after two doses of SARS-CoV-2 BNT162b2 vaccine in solid organ transplant recipients and healthy controls

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Background: Previous studies have indicated inferior responses to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccination in solid organ transplant (SOT) recipients. We examined the development of anti-receptor-binding domain (RBD) immunoglobulin G (IgG) after two doses of BNT162b2b in SOT recipients 6 months after vaccination and compared to that of immunocompetent controls.

Methods: We measured anti-RBD IgG after two doses of BNT162b2 in 200 SOT recipients and 200 matched healthy controls up to 6 months after first vaccination. Anti-RBD IgG concentration and neutralizing capacity of antibodies were measured at first and second doses of BNT162b2 and 2 and 6 months after the first dose. T-cell responses were measured 6 months after the first dose.

Results: In SOT recipients, geometric mean concentration (GMC) of anti-RBD IgG increased from first to second dose (1.14 AU/ml, 95% CI 1.08-1.24 to 11.97 AU/ml, 95% CI 7.73-18.77) and from second dose to 2 months (249.29 AU/ml, 95% CI 153.70-385.19). Six months after the first vaccine, anti-RBD IgG declined (55.85 AU/ml, 95% CI 36.95-83.33). At all time points, anti-RBD IgG was lower in SOT recipients than that in controls. Fewer SOT recipients than controls had a cellular response (13.1% vs. 59.4%, p < 0.001). Risk factors associated with humoral non-response included age [relative risk (RR) 1.23 per 10-year increase, 95% CI 1.11-1.35, p < 0.001], being within 1 year from transplantation (RR 1.55, 95% CI 1.30-1.85, p < 0.001), treatment with mycophenolate (RR 1.54, 95% CI 1.09-2.18, p = 0.015), treatment with corticosteroids (RR 1.45, 95% CI 1.10-1.90, p = 0.009), kidney transplantation (RR 1.70, 95% CI 1.25-2.30, p = 0.001), lung transplantation (RR 1.63, 95% CI 1.16-2.29, p = 0.005), and de novo non-skin cancer comorbidity (RR 1.52, 95% CI, 1.26-1.82, p < 0.001).

Conclusion: Immune responses to BNT162b2 are inferior in SOT recipients compared to healthy controls, and studies aiming to determine the clinical impact of inferior vaccine responses are warranted.

Original languageEnglish
Article number832501
JournalFrontiers in Immunology
Volume13
Number of pages10
ISSN1664-3224
DOIs
Publication statusPublished - 23 Feb 2022

Bibliographical note

Copyright © 2022 Hamm, Møller, Pérez-Alós, Hansen, Pries-Heje, Heftdal, Hasselbalch, Fogh, Madsen, Almagro Armenteros, Knudsen, Poulsen, Frikke-Schmidt, Hilsted, Sørensen, Ostrowski, Harboe, Perch, Sørensen, Rasmussen, Bundgaard, Garred, Iversen and Nielsen.

    Research areas

  • Adult, Antibodies, Neutralizing/blood, Antibodies, Viral/blood, BNT162 Vaccine/immunology, COVID-19/immunology, Cohort Studies, Healthy Volunteers, Humans, Male, Organ Transplantation, Prospective Studies, SARS-CoV-2/physiology, Transplant Recipients, Vaccination, BNT162b2, immunogenicity, COVID-19, SARS-CoV-2, vaccine, solid organ transplant recipient, vaccination

ID: 75622624