SARS-CoV-2 messenger RNA vaccine antibody response and reactogenicity in heart and lung transplant recipients

Andrew M. Hallett, Ross S. Greenberg, Brian J. Boyarsky, Pali D. Shah, Michael T. Ou, Aura T. Teles, Michelle R. Krach, Julia I. López, William A. Werbel, Robin K. Avery, Sunjae Bae, Aaron A. Tobian, Allan B. Massie, Robert S.D. Higgins, Jacqueline M. Garonzik-Wang, Dorry L. Segev, Errol L. Bush

Research output: Contribution to journalArticlepeer-review


Background: While several studies have observed that solid organ transplant recipients experience diminished antibody responses to SARS-CoV-2 mRNA vaccination, data specific to heart and lung transplant (HT/LT) recipients remains sparse. Methods: US adult HT and LT recipients completed their vaccine series between January 7 and April 10, 2021. Reactogencity and SARS-CoV-2 anti-spike antibody were assessed after a priming dose (D1) and booster dose (D2). Modified Poisson regression with robust variance estimator was used to evaluate associations between participant characteristics and antibody development. Results: Of 134 heart recipients, there were 38% non-responders (D1-/D2-), 48% booster responders (D1-/D2+), and 14% priming dose responders (D1+/D2+). Of 103 lung recipients, 64% were non-responders, 27% were booster responders, and 9% were priming dose responders. Lung recipients were less likely to develop antibodies (p < .001). Priming dose antibody response was associated with younger recipient age (p = .04), transplant-to-vaccination time ≥6 years (p < .01), and lack of anti-metabolite maintenance immunosuppression (p < .001). Pain at injection site was the most commonly reported reaction (85% after D1, 76% after D2). Serious reactions were rare, the most common being fatigue (2% after D1 and 3% after D2). No serious adverse events were reported. Conclusions: HT and LT recipients experienced diminished antibody response following vaccination; reactogenicity was comparable to that of the general population. LT recipients may exhibit a more impaired antibody response than HT recipients. While current recommendations are to vaccinate eligible candidates and recipients, further studies characterizing the cell-mediated immune response and clinical efficacy of these vaccines in this population are needed.

Original languageEnglish (US)
Pages (from-to)1579-1588
Number of pages10
JournalJournal of Heart and Lung Transplantation
Issue number12
StatePublished - Dec 2021


  • COVID-19
  • SARS-CoV-2
  • heart transplant
  • lung transplant
  • mRNA vaccination

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation


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