Immunogenicity of the BNT162b2 mRNA vaccine in heart transplant recipients – a prospective cohort study

Osnat Itzhaki Ben Zadok*, Aviv A. Shaul, Binyamin Ben-Avraham, Vicky Yaari, Haim Ben Zvi, Yael Shostak, Barak Pertzov, Noa Eliakim-Raz, Galia Abed, Miriam Abuhazira, Yaron D. Barac, Israel Mats, Mordechai R. Kramer, Dan Aravot, Ran Kornowski, Tuvia Ben-Gal

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

67 Scopus citations


Aims: To assess the short-term immunogenicity to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccine in a population of heart transplant (HTx) recipients. A prospective single-centre cohort study of HTx recipients who received a two-dose SARS-CoV-2 mRNA vaccine (BNT162b2, Pfizer-BioNTech). Methods and results: Whole blood for anti-spike IgG (S-IgG) antibodies was drawn at days 21–26 and at days 35–40 after the first vaccine dose. Geometric mean titres (GMT) ≥50 AU/mL were interpreted positive. Included were 42 HTx recipients at a median age of 61 [interquartile range (IQR) 44–69] years. Median time from HTx to the first vaccine dose was 9.1 (IQR 2.6–14) years. Only 15% of HTx recipients demonstrated the presence of positive S-IgG antibody titres in response to the first vaccine dose [GMT 90 (IQR 54–229) AU/mL]. Overall, 49% of HTx recipients induced S-IgG antibodies in response to either the first or the full two-dose vaccine schedule [GMT 426 (IQR 106–884) AU/mL]. Older age [68 (IQR 59–70) years vs. 46 (IQR 34–63) years, P = 0.034] and anti-metabolite-based immunosuppression protocols (89% vs. 44%, P = 0.011) were associated with low immunogenicity. Importantly, 36% of HTx recipients who were non-responders to the first vaccine dose became S-IgG seropositive in response to the second vaccine dose. Approximately a half of HTx recipients did not generate S-IgG antibodies following SARS-CoV-2 two-dose vaccine. Conclusions: The generally achieved protection from SARS-CoV-2 mRNA vaccination should be regarded with caution in the population of HTx recipients. The possible benefit of additive vaccine should be further studied.

Original languageEnglish
Pages (from-to)1555-1559
Number of pages5
JournalEuropean Journal of Heart Failure
Issue number9
StatePublished - Sep 2021


  • COVID-19
  • Heart transplantation
  • SARS-CoV-2
  • Vaccine


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