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Antibody Response to 2-Dose SARS-CoV-2 mRNA Vaccine Series in Solid Organ Transplant Recipients

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

In contrast to immunocompetent participants in vaccine trials,1,2 a low proportion (17%) of solid organ transplant recipients mounted a positive antibody response to the first dose of SARS-CoV-2 messenger RNA (mRNA) vaccines, with those receiving anti–metabolite maintenance immunosuppression less likely to respond.3 In this study, we assessed antibody response after the second dose.

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Article Information

Corresponding Author: Dorry Segev, MD, PhD, Department of Surgery, Johns Hopkins Medical Institutions, 2000 E Monument St, Baltimore, MD 21205 (dorry@jhmi.edu).

Accepted for Publication: April 26, 2021.

Published Online: May 5, 2021. doi:10.1001/jama.2021.7489

Author Contributions: Drs Garonzik-Wang (principal investigator) and Segev had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Boyarsky, Werbel, Avery, Massie, Segev, Garonzik-Wang.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Boyarsky, Segev, Garonzik-Wang.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Boyarsky, Massie, Segev.

Obtained funding: Segev, Garonzik-Wang.

Administrative, technical, or material support: Boyarsky, Tobian, Massie, Segev, Garonzik-Wang.

Supervision: Werbel, Massie, Segev, Garonzik-Wang.

Conflict of Interest Disclosures: Dr Werbel reported receiving grants from the American Society of Transplantation Research Network Clinical Science Fellowship Grant. Dr Avery reported receiving grants from Aicuris, Astellas, Chimerix, Merck, Oxford Immunotec, Qiagen, and Takeda/Shire. Dr Segev reported serving as a consultant to and receiving honoraria for speaking from Sanofi, Novartis, CSL Behring, Jazz Pharmaceuticals, Veloxis, Mallincrodt, and Thermo Fisher Scientific. No other disclosures were reported.

Funding/Support: This work was supported by the Ben-Dov family; grants F32DK124941 (Dr Boyarsky), K01DK101677 (Dr Massie), and K23DK115908 (Dr Garonzik-Wang) from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); grant K24AI144954 (Dr Segev) from the National Institute of Allergy and Infectious Diseases (NIAID); and by grant gSAN-201C0WW from the Transplantation and Immunology Research Network of the American Society of Transplantation (Dr Werbel).

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the US Department of Health and Human Services. The mention of trade names, commercial products, or organizations does not imply endorsement by the US government.

Additional Contributions: In addition to the individuals recognized previously,3 we also acknowledge the following individuals for their assistance with this study, none of whom was compensated for his or her contributions. Yolanda Eby, MS (Department of Pathology, Johns Hopkins School of Medicine), for data collection; Teresa P-Y. Chiang, MD, MPH (Department of Surgery, Johns Hopkins School of Medicine) for data analysis; Sunjae Bae, MD, PhD (Department of Surgery, Johns Hopkins School of Medicine), for data analysis; Iulia Barbur, BSE (Department of Surgery, Johns Hopkins School of Medicine), for data collection; Muhammad Asad Munir, MBBS (Department of Surgery, Johns Hopkins School of Medicine), for data collection; Andrew H. Karaba, MD, PhD (Department of Medicine, Johns Hopkins School of Medicine), for data analysis; Andrea L. Cox, MD, PhD (Department of Medicine, Johns Hopkins School of Medicine), for data analysis; Justin R. Bailey, MD, PhD (Department of Medicine, Johns Hopkins School of Medicine), for data analysis; Anna P. Durbin, MD (Department of International Health, Johns Hopkins Bloomberg School of Public Health), for data analysis; and Kawsar R. Talaat, MD (Department of International Health, Johns Hopkins Bloomberg School of Public Health), for data analysis.

References
1.
Walsh  EE , Frenck  RW  Jr , Falsey  AR ,  et al.  Safety and immunogenicity of two RNA-based Covid-19 vaccine candidates.   N Engl J Med. 2020;383(25):2439-2450. doi:10.1056/NEJMoa2027906PubMedGoogle ScholarCrossref
2.
Jackson  LA , Anderson  EJ , Rouphael  NG ,  et al; mRNA-1273 Study Group.  An mRNA vaccine against SARS-CoV-2.   N Engl J Med. 2020;383(20):1920-1931. doi:10.1056/NEJMoa2022483PubMedGoogle ScholarCrossref
3.
Boyarsky  BJ , Werbel  WA , Avery  RK ,  et al.  Immunogenicity of a single dose of SARS-CoV-2 messenger RNA vaccine in solid organ transplant recipients.   JAMA. Published online March 15, 2021. doi:10.1001/jama.2021.4385PubMedGoogle Scholar
4.
Klein  SL , Pekosz  A , Park  HS ,  et al.  Sex, age, and hospitalization drive antibody responses in a COVID-19 convalescent plasma donor population.   J Clin Invest. 2020;130(11):6141-6150. doi:10.1172/JCI142004PubMedGoogle ScholarCrossref
5.
Patel  EU , Bloch  EM , Clarke  W ,  et al.  Comparative performance of five commercially available serologic assays to detect antibodies to SARS-CoV-2 and identify individuals with high neutralizing titers.   J Clin Microbiol. Published online January 21, 2021. doi:10.1128/JCM.02257-20PubMedGoogle Scholar
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Mueller  T .  Antibodies against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) in individuals with and without COVID-19 vaccination: a method comparison of two different commercially available serological assays from the same manufacturer.   Clin Chim Acta. 2021;518:9-16. doi:10.1016/j.cca.2021.03.007PubMedGoogle ScholarCrossref
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