Table 1.
Lung Transplant Recipient Characteristics Stratified by Antibody Response to a Three-Dose Regimen of COVID-19 Vaccine
| Variable | Nonresponders to three-dose vaccine regimen n = 79 | Responders to three-dose vaccine regimen n = 47 | p-value |
|---|---|---|---|
| Age, years, median (IQR) | 62.6 (53.7-65.9) | 63.0 (47.3-67.4) | 0.901 |
| Female, n (%) | 26 (32.9) | 21 (44.7) | 0.253 |
| Blood group | 0.788 | ||
| O, n (%) | 35 (44.3) | 22 (46.8) | |
| A, n (%) | 30 (38.0) | 18 (38.3) | |
| B, n (%) | 10 (12.7) | 3 (6.4) | |
| AB, n (%) | 3 (3.8) | 3 (6.4) | |
| Unknown, n (%) | 1 (1.3) | 1 (2.1) | |
| Primary disease | 0.609 | ||
| Chronic obstructive pulmonary disease, n (%) | 40 (50.6) | 20 (42.6) | |
| Cystic fibrosis, n (%) | 10 (12.7) | 8 (17.0) | |
| Interstitial lung disease, n (%) | 8 (10.1) | 3 (6.4) | |
| Other, n (%) | 21 (26.6) | 16 (34.0) | |
| BMI, kg/m², median (IQR) | 23.5 (20.3-26.7) | 23.9 (20.9-28.5) | 0.448 |
| Cardiovascular comorbidities | |||
| Hypertension, n (%) | 46 (58.2) | 26 (55.3) | 0.853 |
| Diabetes mellitus, n (%) | 42 (53.2) | 22 (46.8) | 0.581 |
| Obesity, n (%) | 8 (10.1) | 6 (12.8) | 0.771 |
| Chronic heart failure, n (%) | 2 (2.5) | 2 (4.3) | 0.629 |
| History of transient ischemic attack or stroke, n (%) | 9 (11.4) | 5 (10.6) | >0.999 |
| History of heart attack, n (%) | 6 (7.6) | 6 (12.8) | 0.361 |
| Transplant type | 0.111 | ||
| Double lung transplant, n (%) | 65 (82.3) | 39 (83.0) | |
| Single lung transplant, n (%) | 6 (7.6) | 0 (0.0) | |
| Cardiopulmonary transplant, n (%) | 6 (7.6) | 3 (6.4) | |
| Lung and liver transplant, n (%) | 0 (0.0) | 1 (2.1) | |
| Lung and kidney transplant, n (%) | 2 (2.5) | 2 (4.3) | |
| Lung and islet transplant, n (%) | 0 (0.0) | 2 (4.3) | |
| History of treated allograft acute rejection, n (%) | 25 (31.6) | 9 (19.1) | 0.150 |
| Chronic lung allograft dysfunction, n (%) | 17 (21.5) | 14 (29.8) | 0.393 |
| Maintenance immunosuppression | |||
| Tacrolimus, n (%) | 71 (89.9) | 38 (80.9) | 0.182 |
| Dose, mg, median (IQR) | 4.0 (3.0-7.0) | 4.0 (3.0-4.6) | 0.086 |
| Trough level, µg/L, median (IQR) | 7.5 (6.4-8.8) | 6.1 (5.6-7.4) | <0.001 |
| Cyclosporine, n (%) | 8 (10.1) | 6 (12.8) | 0.771 |
| MMF/MPA, n (%) | 69 (87.3) | 33 (70.2) | 0.033 |
| Dose, mg, median (IQR) | 1,750 (1,000-2,000) | 1,080 (1,000-2,000) | 0.031 |
| Trough level, mg/L, median (IQR) | 2.8 (2.0-4.9) | 2.2 (1.7-2.9) | 0.022 |
| Azathioprine, n (%) | 3 (3.8) | 10 (21.3) | 0.004 |
| Prednisone, n (%) | 77 (97.4) | 43 (91.4) | 0.195 |
| Dose, mg, median (IQR, range) | 10 (10-10, 0-10) | 10 (10-10, 0-40) | 0.039 |
| Everolimus, n (%) | 9 (11.4) | 8 (17.0) | 0.424 |
| COVID-19 vaccine | 0.004 | ||
| mRNA-1273, n (%) | 53 (67.1) | 42 (89.4) | |
| BNT162b2, n (%) | 26 (32.9) | 4 (8.5) | |
| mRNA-1273 + BNT162b2, n (%) | 0 (0.0) | 1 (2.1) | |
| Biology | |||
| Creatinine, µmol/L, median (IQR) | 102.9 (80.2-136.4) | 109.9 (84.2-133.0) | 0.732 |
| Leucocytes, G/L, median (IQR) | 6.0 (4.7-8.3) | 6.5 (5.4-7.7) | 0.578 |
| Lymphocytes, G/L, median (IQR) | 1.4 (0.9-1.7) | 1.5 (1.1-1.9) | 0.506 |
| Monocytes, G/L, median (IQR) | 0.6 (0.5-0.8) | 0.6 (0.5-0.8) | 0.453 |
| CRP, mg/L, median (IQR) | <4.0 (<4.0-5.8) | <4.0 (<4.0-7.0) | 0.965 |
| Prevaccine TTV viral load, log10 cp/mL, median (IQR) | 4.9 (3.4-7.7) | 3.8 (2.5-5.4) | 0.004 |
| Time between transplantation and first vaccination, years, median (IQR) | 4.9 (1.7-8.3) | 5.9 (4.2-9.3) | 0.022 |
| Time of 2nd vaccine from 1st vaccine, days, median (IQR) | 28.0 (28.0-30.0) | 28.0 (28.0-28.0) | 0.145 |
| Time of 3rd vaccine from 2nd vaccine, days, median (IQR) | 56.0 (34.0-74.0) | 62.0 (39.0-71.0) | 0.945 |
| Time of 3rd vaccine to antibody testing, days, median (IQR) | 35.0 (24.0-47.0) | 32.0 (25.0-42.0) | 0.137 |
| Maximum anti-RBD IgG concentration after third dose, BAU/mL, median (IQR) | <1.0 (<1.0-1.2) | 108.0 (34.1-326.3) | <0.001 |
BAU, Binding Antibody Units; BMI, body mass index; CRP, C-reactive protein; IQR, interquartile range; MMF/MPA, mycophenolate mofetil/mycophenolic acid; TTV, Torque teno virus.
Age, biological parameters, and medication data (including dose and trough levels) were assessed just before the first vaccine dose. Patient characteristics were compared between responders (patients displaying anti-RBD IgG ≥7.1 BAU/mL) and nonresponders using the Fisher exact test and χ2 test for dichotomous variables and the Mann-Whitney U-test for continuous variables with Graphpad Prism version 9.3.1. software. Statistical significance was set at p < 0.05 (shown in bold).