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COVID-19 Vaccine Triggered Rejection in Lung Transplant Recipients: A Case Series
PURPOSE: Anti-severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) vaccination is recommended by AST, ISHLT, and CDC in all transplant recipients. Lung transplant recipients (LTR) are at a higher risk of developing severe symptoms due to higher immunosuppression (IS) and baseline compromise...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Published by Elsevier Inc.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8988696/ http://dx.doi.org/10.1016/j.healun.2022.01.1352 |
_version_ | 1784683020231376896 |
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author | Alsunaid, S. Caputo, V. Stryker, K. Diouf, J. Abbasi, M. Borgi, J. Forest, S. Mansour, A. |
author_facet | Alsunaid, S. Caputo, V. Stryker, K. Diouf, J. Abbasi, M. Borgi, J. Forest, S. Mansour, A. |
author_sort | Alsunaid, S. |
collection | PubMed |
description | PURPOSE: Anti-severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) vaccination is recommended by AST, ISHLT, and CDC in all transplant recipients. Lung transplant recipients (LTR) are at a higher risk of developing severe symptoms due to higher immunosuppression (IS) and baseline compromised graft function. Limited antibody response to messenger RNA (mRNA) vaccines has been reported in LTR, with the majority mounting a response after the 2nd dose. In this series, 3 patients developed new and significant respiratory compromise after their 2(nd) vaccine dose consistent with antibody mediated rejection (AMR). To our knowledge, this is the first published case series of vaccine induced rejection in LTR. METHODS: Retrospective chart review of our cohort showed 46% fully vaccinated and an additional 2.5% partially vaccinated patients. Three fully vaccinated patients with approved mRNA vaccines (2 Moderna, 1 Pfizer-BioNTech) were identified after developing severe respiratory compromise post 2(nd) vaccine dose. Evaluation revealed AMR as the underlying etiology. RESULTS: All patients were female, ages 50-70 years old, between 6 months and 2 years post-transplant. No previous rejection episodes. All were on standard IS as per institution protocols. Two were hospitalized with hypoxic respiratory failure within 2 weeks of their 2(nd) vaccine dose. The 3(rd) was seen at clinic for milder similar symptoms, later progressing and requiring supplemental oxygen (O2) and hospitalization. Imaging showed new lung infiltrates, infectious work up was negative. Biopsies did not show any cellular rejection. All developed new DSAs and received treatment for AMR with plasmapheresis, IVIg, and Rituximab. Two recovered their lung function and are off supplemental O2, the 3(rd) did not and is re-listed for transplant. CONCLUSION: While LTR have a diminished response to SARS-CoV-2 vaccines making them more vulnerable to the disease, their immune system's response may not always be clear. We report three cases of patients developing severe AMR from new DSAs that appear to be triggered by the COVID-19 vaccine. This vaccine responses should be collected in a database where each case can be investigated to help better understand the mechanism behind them and hopefully identifying LTR at risk. This can then be used to modify vaccination strategies and aid in preventing adverse outcomes in this vulnerable group of patients. |
format | Online Article Text |
id | pubmed-8988696 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Published by Elsevier Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-89886962022-04-11 COVID-19 Vaccine Triggered Rejection in Lung Transplant Recipients: A Case Series Alsunaid, S. Caputo, V. Stryker, K. Diouf, J. Abbasi, M. Borgi, J. Forest, S. Mansour, A. J Heart Lung Transplant (1331) PURPOSE: Anti-severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) vaccination is recommended by AST, ISHLT, and CDC in all transplant recipients. Lung transplant recipients (LTR) are at a higher risk of developing severe symptoms due to higher immunosuppression (IS) and baseline compromised graft function. Limited antibody response to messenger RNA (mRNA) vaccines has been reported in LTR, with the majority mounting a response after the 2nd dose. In this series, 3 patients developed new and significant respiratory compromise after their 2(nd) vaccine dose consistent with antibody mediated rejection (AMR). To our knowledge, this is the first published case series of vaccine induced rejection in LTR. METHODS: Retrospective chart review of our cohort showed 46% fully vaccinated and an additional 2.5% partially vaccinated patients. Three fully vaccinated patients with approved mRNA vaccines (2 Moderna, 1 Pfizer-BioNTech) were identified after developing severe respiratory compromise post 2(nd) vaccine dose. Evaluation revealed AMR as the underlying etiology. RESULTS: All patients were female, ages 50-70 years old, between 6 months and 2 years post-transplant. No previous rejection episodes. All were on standard IS as per institution protocols. Two were hospitalized with hypoxic respiratory failure within 2 weeks of their 2(nd) vaccine dose. The 3(rd) was seen at clinic for milder similar symptoms, later progressing and requiring supplemental oxygen (O2) and hospitalization. Imaging showed new lung infiltrates, infectious work up was negative. Biopsies did not show any cellular rejection. All developed new DSAs and received treatment for AMR with plasmapheresis, IVIg, and Rituximab. Two recovered their lung function and are off supplemental O2, the 3(rd) did not and is re-listed for transplant. CONCLUSION: While LTR have a diminished response to SARS-CoV-2 vaccines making them more vulnerable to the disease, their immune system's response may not always be clear. We report three cases of patients developing severe AMR from new DSAs that appear to be triggered by the COVID-19 vaccine. This vaccine responses should be collected in a database where each case can be investigated to help better understand the mechanism behind them and hopefully identifying LTR at risk. This can then be used to modify vaccination strategies and aid in preventing adverse outcomes in this vulnerable group of patients. Published by Elsevier Inc. 2022-04 2022-04-07 /pmc/articles/PMC8988696/ http://dx.doi.org/10.1016/j.healun.2022.01.1352 Text en Copyright © 2022 Published by Elsevier Inc. 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. |
spellingShingle | (1331) Alsunaid, S. Caputo, V. Stryker, K. Diouf, J. Abbasi, M. Borgi, J. Forest, S. Mansour, A. COVID-19 Vaccine Triggered Rejection in Lung Transplant Recipients: A Case Series |
title | COVID-19 Vaccine Triggered Rejection in Lung Transplant Recipients: A Case Series |
title_full | COVID-19 Vaccine Triggered Rejection in Lung Transplant Recipients: A Case Series |
title_fullStr | COVID-19 Vaccine Triggered Rejection in Lung Transplant Recipients: A Case Series |
title_full_unstemmed | COVID-19 Vaccine Triggered Rejection in Lung Transplant Recipients: A Case Series |
title_short | COVID-19 Vaccine Triggered Rejection in Lung Transplant Recipients: A Case Series |
title_sort | covid-19 vaccine triggered rejection in lung transplant recipients: a case series |
topic | (1331) |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8988696/ http://dx.doi.org/10.1016/j.healun.2022.01.1352 |
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