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Humoral and Cellular Response of Transplant Recipients to a Third Dose of mRNA SARS-CoV-2 Vaccine: A Systematic Review and Meta-analysis.
Bailey, Adrian J M; Maganti, Harinad B; Cheng, Wei; Shorr, Risa; Arianne Buchan, C; Allan, David S.
  • Bailey AJM; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
  • Maganti HB; Canadian Blood Services, Stem Cells and Centre for Innovation, Ottawa, ON, Canada.
  • Cheng W; Canadian Blood Services, Stem Cells and Centre for Innovation, Ottawa, ON, Canada.
  • Shorr R; Clinical Epidemiology and Regenerative Medicine, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
  • Arianne Buchan C; Department of Biostatistics, Yale School of Public Health, New Haven, CT.
  • Allan DS; Library and Information Services, The Ottawa Hospital, Ottawa, ON, Canada.
Transplantation ; 2022 Nov 04.
Article in English | MEDLINE | ID: covidwho-2227850
ABSTRACT

BACKGROUND:

High rates of nonresponse to 2 doses of mRNA severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine have been reported in transplant recipients. Several studies have investigated the efficacy of a third dose in this population. However, efficacy remains unclear, as response rates vary across studies. Therefore, we conducted a systematic review and meta-analysis to determine the efficacy of a third dose of any mRNA SARS-CoV-2 vaccine in transplant recipients.

METHODS:

Preferred Reporting Items for Systematic Review and Meta-Analysis reporting guidelines (PROSPEROCRD42021281498) were followed. Medline, Embase, and CENTRAL were searched from inception to December 2, 2021, without restrictions. All full-text studies reporting on the efficacy of a third dose of any mRNA SARS-CoV-2 vaccine in pediatric and adult transplant recipients were included. The National Institutes of Health quality assessment tool for case series and the Cochrane risk of bias tool determined study quality. Meta-analysis was performed via the DerSimonian-Laird random-effect model.

RESULTS:

Of 84 records, 12 studies totaling 1257 patients met inclusion criteria. One study was a randomized controlled trial, whereas all other studies were observational. Across 7 studies (801 patients), humoral response after 3 doses was observed in 66.1% (95% confidence interval, 62.8%-69.4%; I2 = 0%) of transplant recipients. Triple immunosuppression, mycophenolate, antiproliferatives, and belatacept use were associated with reduced odds of humoral response in studies reporting multivariate analyses. Transplant recipients receiving a third dose displayed higher levels of neutralizing antibodies to SARS-CoV-2 variants (Alpha, Beta, and Delta) compared with placebo.

CONCLUSIONS:

A third dose SARS-CoV-2 mRNA vaccine should be strongly considered in transplant recipients. Limitations included lack of controlled studies and clinically relevant thresholds to determine response to vaccination.

Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Topics: Vaccines / Variants Language: English Year: 2022 Document Type: Article Affiliation country: TP.0000000000004386

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Topics: Vaccines / Variants Language: English Year: 2022 Document Type: Article Affiliation country: TP.0000000000004386