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Abstract：
OBJECTIVE: Solid organ transplant recipients have an increased risk of developing severe coronavirus disease 2019 (COVID-19). Although SARS-CoV-2 mRNA vaccination has been strongly recommended for solid organ transplant recipients, its efficacy and safety have remained unknown.
METHODS: We performed an observational prospective cohort study in 18 lung transplant recipients who received two doses of SARS-CoV-2 mRNA vaccine, including BNT162b2 (n = 17) or mRNA-1273 (n = 1), between June and October 2021. The titers of IgG antibodies against the SARS-CoV-2 spike protein (S-IgG) were measured in serum samples collected before the prime dose, three weeks after the prime dose, and four weeks after the booster dose. Reactogenicity and adverse events were evaluated after vaccination.
RESULTS: There were no recipients with previous SARS-CoV-2 infection prior to vaccination. S-IgG levels were elevated in 2/18 (11.1%) recipients after the prime dose and in 5/18 recipients (27.8%) after the booster dose (31.7 ± 30.6 U/ml). The time from transplantation to vaccination tended to be longer in the seropositive group than the seronegative group [7.5 (3.9-10.2) vs 2.8 (1.9-4.0) years, p = 0.059]. Maintenance dose of mycophenolate mofetil tended to be lower in the seropositive group than in the seronegative group [500 (250-500) vs 1000 (1000-1000) mg/day, p = 0.088]. Regarding the adverse events after vaccination, the development of chronic lung allograft dysfunction (CLAD) or antibody-mediated rejection (AMR) were observed in two seropositive patients.
CONCLUSIONS: The antibody response to the SARS-CoV-2 mRNA vaccine was quite poor in lung transplant recipients. We experienced cases that developed clinical CLAD or AMR that was likely related to SARS-CoV-2 vaccination.
METHODS: We performed an observational prospective cohort study in 18 lung transplant recipients who received two doses of SARS-CoV-2 mRNA vaccine, including BNT162b2 (n = 17) or mRNA-1273 (n = 1), between June and October 2021. The titers of IgG antibodies against the SARS-CoV-2 spike protein (S-IgG) were measured in serum samples collected before the prime dose, three weeks after the prime dose, and four weeks after the booster dose. Reactogenicity and adverse events were evaluated after vaccination.
RESULTS: There were no recipients with previous SARS-CoV-2 infection prior to vaccination. S-IgG levels were elevated in 2/18 (11.1%) recipients after the prime dose and in 5/18 recipients (27.8%) after the booster dose (31.7 ± 30.6 U/ml). The time from transplantation to vaccination tended to be longer in the seropositive group than the seronegative group [7.5 (3.9-10.2) vs 2.8 (1.9-4.0) years, p = 0.059]. Maintenance dose of mycophenolate mofetil tended to be lower in the seropositive group than in the seronegative group [500 (250-500) vs 1000 (1000-1000) mg/day, p = 0.088]. Regarding the adverse events after vaccination, the development of chronic lung allograft dysfunction (CLAD) or antibody-mediated rejection (AMR) were observed in two seropositive patients.
CONCLUSIONS: The antibody response to the SARS-CoV-2 mRNA vaccine was quite poor in lung transplant recipients. We experienced cases that developed clinical CLAD or AMR that was likely related to SARS-CoV-2 vaccination.
摘要：
目标：实体器官移植受者患2019年严重冠状病毒病（COVID-19）的风险增加。尽管已强烈建议实体器官移植受者接种SARS-CoV-2mRNA疫苗，其疗效和安全性尚不清楚.
方法：我们在18名接受两剂SARS-CoV-2mRNA疫苗的肺移植受者中进行了一项观察性前瞻性队列研究，包括BNT162b2（n=17）或mRNA-1273（n=1），2021年6月至10月。在主要剂量之前收集的血清样品中测量针对SARS-CoV-2刺突蛋白（S-IgG）的IgG抗体滴度，给药三周后，加强剂量后四周。疫苗接种后评估反应性和不良事件。
结果：在接种疫苗之前，没有接受过SARS-CoV-2感染的患者。初次剂量后2/18（11.1％）的接受者和加强剂量后5/18的接受者（27.8％）的S-IgG水平升高（31.7±30.6U/ml）。血清阳性组移植到接种疫苗的时间往往比血清阴性组长[7.5（3.9-10.2）vs2.8（1.9-4.0）年，p=0.059]。霉酚酸酯的维持剂量在血清阳性组中倾向于低于血清阴性组[500（250-500）对1000（1000-1000）mg/天，p=0.088]。关于疫苗接种后的不良事件，在两名血清阳性患者中观察到慢性肺同种异体移植功能障碍(CLAD)或抗体介导的排斥反应(AMR)的发展.
结论：肺移植受者对SARS-CoV-2mRNA疫苗的抗体反应相当差。我们经历了可能与SARS-CoV-2疫苗接种有关的临床CLAD或AMR的病例。
方法：我们在18名接受两剂SARS-CoV-2mRNA疫苗的肺移植受者中进行了一项观察性前瞻性队列研究，包括BNT162b2（n=17）或mRNA-1273（n=1），2021年6月至10月。在主要剂量之前收集的血清样品中测量针对SARS-CoV-2刺突蛋白（S-IgG）的IgG抗体滴度，给药三周后，加强剂量后四周。疫苗接种后评估反应性和不良事件。
结果：在接种疫苗之前，没有接受过SARS-CoV-2感染的患者。初次剂量后2/18（11.1％）的接受者和加强剂量后5/18的接受者（27.8％）的S-IgG水平升高（31.7±30.6U/ml）。血清阳性组移植到接种疫苗的时间往往比血清阴性组长[7.5（3.9-10.2）vs2.8（1.9-4.0）年，p=0.059]。霉酚酸酯的维持剂量在血清阳性组中倾向于低于血清阴性组[500（250-500）对1000（1000-1000）mg/天，p=0.088]。关于疫苗接种后的不良事件，在两名血清阳性患者中观察到慢性肺同种异体移植功能障碍(CLAD)或抗体介导的排斥反应(AMR)的发展.
结论：肺移植受者对SARS-CoV-2mRNA疫苗的抗体反应相当差。我们经历了可能与SARS-CoV-2疫苗接种有关的临床CLAD或AMR的病例。
