Liver Diseases Center, Sheba Medical Center, Tel Aviv, Israel.
Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Israel.
J Hepatol. 2022 Sep;77(3):702-709. doi: 10.1016/j.jhep.2022.03.042. Epub 2022 Apr 19.
BACKGROUND & AIMS: Immune responses of solid organ transplant recipients to 2 doses of the BNT162b2 mRNA anti-SARS-CoV-2 vaccine are impaired. The immunogenicity and safety of a third dose among liver transplant (LT) recipients are unknown. This work aimed to evaluate the immune response of LT recipients to a third dose of the BNT162b2 mRNA vaccine.
Consecutive LT recipients (n = 61) in follow-up at Sheba Medical Center were included. Receptor binding domain (RBD) IgG, neutralizing antibody (NA) titers, and T-cell levels before and 21-28 days after a third vaccine dose were determined. Adverse effects after the third dose were monitored.
The median age of LT recipients was 65 years and 57.4% were male. The humoral immune response rate improved significantly, with 56% of patients showing a response before the third vaccine dose compared to 98% after the third dose. The cellular response in 12 evaluated patients improved significantly (p = 0.008). The geometric mean of anti-RBD IgG levels, NA levels, and T-cell count also increased significantly after the third dose. NA titers after the third dose negatively correlated with age (p = 0.03), mycophenolate mofetil treatment (p = 0.005), and combined immunosuppression as opposed to calcineurin inhibitor monotherapy (p = 0.001). After the third dose, adverse effects were reported by 37% of recipients and were mostly mild (local pain and fatigue).
After a third BNT162b2 mRNA vaccine, the immune response improved significantly among LT recipients, without serious adverse effects. Further studies are needed to evaluate immune response durability and to determine the optimal number and schedule of booster vaccine doses.
The Pfizer-Biotech BNT162b2SARS-CoV-2 vaccine induced significant immunity among liver transplant recipients after a third dose. The majority of the patients developed sufficient levels of both humoral and cellular immune responses. Factors that predict non-response were older age and immunosuppressive medications.
实体器官移植受者对 2 剂 BNT162b2 mRNA 抗 SARS-CoV-2 疫苗的免疫反应受损。肝移植（LT）受者接种第三剂疫苗的免疫原性和安全性尚不清楚。本研究旨在评估 LT 受者接种第三剂 BNT162b2 mRNA 疫苗的免疫反应。
纳入在谢巴医疗中心接受随访的连续 LT 受者（n=61）。在接种第三剂疫苗前和 21-28 天后，测定受体结合域（RBD）IgG、中和抗体（NA）滴度和 T 细胞水平。监测第三剂疫苗后的不良反应。
LT 受者的中位年龄为 65 岁，57.4%为男性。体液免疫反应率显著提高，接种第三剂疫苗前有 56%的患者出现反应，接种第三剂疫苗后有 98%的患者出现反应。12 例评估患者的细胞反应显著改善（p=0.008）。接种第三剂疫苗后，抗 RBD IgG 水平、NA 水平和 T 细胞计数的几何均数也显著增加。第三剂疫苗后，NA 滴度与年龄（p=0.03）、吗替麦考酚酯治疗（p=0.005）以及联合免疫抑制治疗而非钙调神经磷酸酶抑制剂单药治疗（p=0.001）呈负相关。接种第三剂疫苗后，37%的受者报告出现不良反应，大多为轻度（局部疼痛和疲劳）。
LT 受者接种第三剂 BNT162b2 mRNA 疫苗后，免疫反应显著改善，无严重不良反应。需要进一步研究来评估免疫反应的持久性，并确定最佳的加强疫苗剂量和接种方案。
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