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. 2022 Jul 16;41(10):1429–1439. doi: 10.1016/j.healun.2022.07.008

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© 2022 International Society for Heart and Lung Transplantation. All rights reserved.

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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Investigation of predictors of vaccine response in COVID-19-naive lung transplant recipients (n = 125). (A) Vaccine response rates after the second and the third vaccine doses according to mRNA vaccine type. The number of responders to each vaccine dose is detailed below the bar chart. (B) Prevaccine TTV viral load in nonresponders (n = 78) and responders (n = 47) to a three-dose regimen of COVID-19 mRNA-based vaccine, with medians represented as solid horizontal lines. The dotted line indicates the predictive threshold of 6.2 log₁₀ cp/mL. Comparison was computed with Mann-Whitney test using Graphpad Prism version 9.3.1. software. (C) Receiver operating characteristics (ROC) curve for prediction of vaccine response based on prevaccine TTV viral load. Area under the curve (AUC): 0.6533. The threshold of 6.2 log cp/mL is associated with a negative predictive value of 93.5% (in case of high TTV viral load) and a positive predictive value of 47.9% (in case of low TTV viral load) for vaccine response in this cohort. (D) Bar charts representing the percentage of responders after three vaccine doses according to the prevaccine TTV viral load and to MMF/MPA treatment at the time of the first vaccination. The number of LTR in each category of patients is mentioned above bars. (E) Spearman correlation between TTV viral load and MPA trough level measured at the same time before vaccination in responders (black dots) and nonresponders (grey dots) to three vaccine doses. The dotted line indicates the TTV viral load predictive threshold of 6.2 log₁₀ cp/mL. Correlation coefficient (r_S) was calculated using the Graphpad Prism version 9.3.1. software. (F) Forest plot showing Odds Ratios (OR) estimates (indicated by black dots) and 95% confidence intervals (indicated by whiskers) of association between patient characteristics and lack of vaccine response to a three-dose regimen of COVID-19 mRNA-based vaccine. Multivariable logistic regression analysis was performed using SPSS 28.0 (IBM Statistics). Factors independently associated with poor vaccine response are in bold. MMF/MPA: mycophenolate mofetil/mycophenolic acid; OR: Odds ratio; TTV: Torque teno virus; VL: viral load. **p value <0.010, ns: not significant.