High Immune Response Rate to the Fourth Boost of the BNT162b2 Vaccine against the Omicron Variants of Concern among Liver Transplant Recipients

Yana Davidov, Victoria Indenbaum, Nofar Atari, Limor Kliker, Keren Tsaraf, Keren Asraf, Oranit Cohen-Ezra, Mariya Likhter, Orna Mor, Ram Doolman, Yael Weiss-Ottolenghi, Tammy Hod, Arnon Afek, Yitshak Kreiss, Yaniv Lustig, Gili Regev-Yochay, Michal Mandelboim, Ziv Ben-Ari

Research output: Contribution to journalArticlepeer-review

Abstract

The immune response of liver transplant (LT) recipients to a third dose of the BNT162b2 mRNA vaccine significantly waned after four months. We aimed to evaluate the immune response and breakthrough infection rates of a fourth dose against the Omicron variants among LT recipients. LT recipients who had no past or active SARS-CoV-2 infection and received three doses of the BNT162b2mRNA vaccine were included. Of the 73 LT recipients, 50 (68.5%) received a fourth dose. The fourth dose was associated with a significantly higher positive immune response than the third dose. Receptor-binding domain (RBD) IgG and Omicron BA.1 and BA.2 neutralizing antibodies were determined at a median of 132 and 29 days after the third and fourth vaccines. They were 345 binding antibody units per milliliter (BAU/mL) vs. 2118 BAU/mL (p < 0.0001), 10 vs. 87 (p < 0.0001), and 15 vs. 149 (p = 0.001), respectively. Breakthrough infections were documented among nine (18%) LT recipients after the fourth dose and among seven (30.4%) patients following the third dose (p = 0.2); 93.5% of breakthrough infections were mild. The infection rate after the fourth dose was higher among diabetic vs. nondiabetic recipients (33.3% vs. 6.9%, respectively; p = 0.02). Further studies are needed to evaluate additional factors influencing the breakthrough infection rate among LT recipients.

Original languageEnglish
Article number2769
JournalViruses
Volume14
Issue number12
DOIs
StatePublished - Dec 2022

Funding

FundersFunder number
Sheba Medical Center

    Keywords

    • BNT162b2 mRNA
    • breakthrough infection
    • fourth dose
    • immune response
    • liver transplant recipients
    • side effects BNT162b2 mRNA vaccine

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