Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Eur J Cardiothorac Surg. 2022 Sep 2;62(4). doi: 10.1093/ejcts/ezac145.
The immunogenicity of two-dose severe acute respiratory syndrome coronavirus 2 vaccine is lower among heart transplant (HTx) recipients, compared with the general population. Our aim was to assess the immunogenicity of a third-dose vaccine in HTx recipients.
This is a prospective cohort study of HTx recipients who received a third dose of the BNT162b2 vaccine. Immunogenicity was assessed by serum levels of anti-spike immunoglobulin G (S-IgG), taken at baseline and 14-28 days after the third dose. Titres above 50 U/ml were interpreted positive.
We Included 42 HTx recipients at a median age of 65 years [interquartile range (IQR) 58-70]. At baseline, the median of 27 days (IQR 13-42) before the third dose and the median titre of the whole group was 18 U/ml (IQR 4-130). Only 14 patients (33%) were S-IgG seropositive. After the third dose, the proportion of seropositive patients increased significantly to 57% (P = 0.05) and the median titre increased significantly to 633 U/ml (IQR 7-6104, P < 0.0001). Younger age at HTx (OR per 1-year decrease 1.07, P = 0.05), low tacrolimus serum level (OR per 1-unit decrease 2.28, P = 0.02), mammalian target of rapamycin use (OR 13.3, P = 0.003), lack of oral steroids use (OR 4.17, P = 0.04) and lack of calcineurin inhibitor use (71% of responders vs 100% non-responders received calcineurin inhibitors, P = 0.01) were predictors of seropositive result after the third dose. However, no significant association was detected following adjustment for baseline S-IgG titre.
Third-dose booster of BNT162b2 vaccine significantly increased immunogenicity among HTx recipients who previously received a two-dose vaccine.
与一般人群相比，两剂严重急性呼吸综合征冠状病毒 2 疫苗在心脏移植（HTx）受者中的免疫原性较低。我们的目的是评估 HTx 受者第三剂疫苗的免疫原性。
这是一项前瞻性队列研究，纳入接受 BNT162b2 疫苗第三剂的 HTx 受者。通过在第三剂后 14-28 天测量血清抗刺突免疫球蛋白 G（S-IgG）水平评估免疫原性。滴度高于 50 U/ml 被解释为阳性。
我们纳入了 42 名中位年龄为 65 岁（IQR 58-70）的 HTx 受者。在第三剂前中位数 27 天（IQR 13-42）时，整个组的中位数滴度为 18 U/ml（IQR 4-130）。只有 14 名患者（33%）S-IgG 血清阳性。第三剂后，血清阳性患者的比例显著增加至 57%（P = 0.05），中位数滴度显著增加至 633 U/ml（IQR 7-6104，P < 0.0001）。HTx 时年龄较小（每 1 岁降低的 OR 为 1.07，P = 0.05）、低他克莫司血清水平（每 1 单位降低的 OR 为 2.28，P = 0.02）、使用哺乳动物雷帕霉素靶蛋白（OR 13.3，P = 0.003）、不使用口服皮质类固醇（OR 4.17，P = 0.04）和不使用钙调神经磷酸酶抑制剂（接受钙调神经磷酸酶抑制剂治疗的应答者为 71%，而非应答者为 100%，P = 0.01）是第三剂后血清阳性结果的预测因素。然而，在调整基线 S-IgG 滴度后，未发现显著相关性。
在先前接受两剂疫苗的 HTx 受者中，BNT162b2 疫苗第三剂加强剂显著提高了免疫原性。
