Improved immunogenicity following the third dose of BNT162b2 mRNA vaccine in heart transplant recipients

Aviv Avraham Shaul*, Osnat Itzhaki Ben Zadok, Binyamin Ben-Avraham, Vicky Yaari, Alon Barsheshet, Amos Levi, Haim Ben Zvi, Noa Eliakim Raz, Galia Abed, Miriam Abuhazira, Mahmood Abu Akel, Israel Mats, Yaron D. Barac, Dan Aravot, Ran Kornowski, Tuvia Ben-Gal

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


OBJECTIVES: The immunogenicity of two-dose severe acute respiratory syndrome coronavirus 2 vaccine is lower among heart transplant (HTx) recipients, compared with the general population. Our aim was to assess the immunogenicity of a third-dose vaccine in HTx recipients. METHODS: This is a prospective cohort study of HTx recipients who received a third dose of the BNT162b2 vaccine. Immunogenicity was assessed by serum levels of anti-spike immunoglobulin G (S-IgG), taken at baseline and 14-28 days after the third dose. Titres above 50 U/ml were interpreted positive. RESULTS: We Included 42 HTx recipients at a median age of 65 years [interquartile range (IQR) 58-70]. At baseline, the median of 27 days (IQR 13-42) before the third dose and the median titre of the whole group was 18 U/ml (IQR 4-130). Only 14 patients (33%) were S-IgG seropositive. After the third dose, the proportion of seropositive patients increased significantly to 57% (P = 0.05) and the median titre increased significantly to 633 U/ml (IQR 7-6104, P < 0.0001). Younger age at HTx (OR per 1-year decrease 1.07, P = 0.05), low tacrolimus serum level (OR per 1-unit decrease 2.28, P = 0.02), mammalian target of rapamycin use (OR 13.3, P = 0.003), lack of oral steroids use (OR 4.17, P = 0.04) and lack of calcineurin inhibitor use (71% of responders vs 100% non-responders received calcineurin inhibitors, P = 0.01) were predictors of seropositive result after the third dose. However, no significant association was detected following adjustment for baseline S-IgG titre. CONCLUSIONS: Third-dose booster of BNT162b2 vaccine significantly increased immunogenicity among HTx recipients who previously received a two-dose vaccine.

Original languageEnglish
Article numberezac145
JournalEuropean Journal of Cardio-thoracic Surgery
Issue number4
StatePublished - 1 Oct 2022


  • BNT162b2 vaccine
  • COVID-19
  • Heart transplantation
  • Severe acute respiratory syndrome coronavirus 2
  • Third dose


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