Antibody Response to 2-Dose SARS-CoV-2 mRNA Vaccine Series in Solid Organ Transplant Recipients | Surgery | JAMA | JAMA Network
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    2 Comments for this article
    Effect of Second Dose of COVID-19 mRNA Vaccine on Transplant Recipients
    Takuma Hayashi, MBBS, DMSci, GMRC, PhD | National Hospital Organization Kyoto Medical Center
    Although Boyarsky BJ et al. demonstrate an improvement in anti-spike antibody responses in transplant recipients after dose 2 compared with dose 1, their data suggest that a substantial proportion of transplant recipients likely remain at risk for COVID-19 after 2 doses of mRNA vaccine.

    Since transplant recipients must always take immunosuppressive drugs, we believe that transplant recipients do not have higher anti-SARS-CoV-2 antibody titers after COVID-19 mRNA vaccination compared to healthy individuals.

    The following contents have been published at the Japanese Society for Organ Transplantation.

    Generally, it has been reported that poor effect of the vaccine under
    taking immunosuppressive drugs. COVID-19 mRNA vaccination should be prioritized for transplant recipients.
    The prognosis for transplant recipients who develop COVID-19 is significantly poor. Therefore, COVID-19 mRNA vaccination is recommended for transplant recipients to prevent SARS-CoV-2 infection.
    COVID-19 mRNA vaccination is recommended for transplant recipients, even if the transplant recipient has previously developed COVID-19 or has antibodies to SARS-CoV-2.
    After COVID-19 mRNA vaccination, transplant recipients should wear masks, maintain social distance, and avoid stagnation.

    In general, the antiviral effect of vaccination depends on the immune activation of the vaccinated person. Therefore, it is essential to develop an anti-SARS-CoV-2 drug to prevent the serious illness of COVID-19 for transplant recipients who take daily immunosuppressive drugs.

    Dr. Hayashi T. Dr. Konishi I.
    National Hospital Organization Kyoto Medical Center
    Effectiveness of COVID-19 vaccines at population level not yet estimated
    Sandro Tsang, PhD | People's Open Access Education Initiative
    For transplant recipients (not) receiving antimetabolites, (32%) 57% had no antibody response after 2 doses of mRNA vaccine. This finding implies that vaccinating immunocompromised individuals against COVID-19 with mRNA vaccine appears ineffective at individual levels. However, the virus can evolve within a host hidden for months and be transmitted to others (1). I hope that estimates of the effectiveness of different COVID-19 vaccines from a population health perspective will soon become available in the research pipeline. In any case, immunocompromised individuals should always be given priority to receive the vaccines to their own accord, since they are vulnerable individuals.


    Abbasi J. Researchers Tie Severe Immunosuppression to Chronic COVID-19 and Virus Variants. JAMA. 2021;325(20):2033-2035. doi:10.1001/jama.2021.7212.
    Research Letter
    May 5, 2021

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

    Author Affiliations
    • 1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
    • 2Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
    • 3Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland
    JAMA. 2021;325(21):2204-2206. doi:10.1001/jama.2021.7489

    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.

    Transplant recipients without prior polymerase chain reaction–confirmed COVID-19 were recruited from across the US to participate in this prospective cohort through a digital campaign. Those who completed the 2-dose SARS-CoV-2 mRNA vaccine series between December 16, 2020, and March 13, 2021, were included and followed up through April 13, 2021. As described previously,3 semiquantitative antispike serologic testing was undertaken with the Roche Elecsys anti–SARS-CoV-2 S enzyme immunoassay, positive cutoff of at least 0.8 U/mL, which tests for the receptor-binding domain of the SARS-CoV-2 spike protein, or the EUROIMMUN enzyme immunoassay, positive cutoff of at least 1.1 arbitrary units, which tests for the S1 domain of SARS-CoV-2 spike protein, both key measures of humoral immune response.4,5 This study was approved by the Johns Hopkins institutional review board; participants provided informed consent electronically.