Vaccination reduces SARS-CoV-2 infection, mortality risk in heart transplant recipients
Unvaccinated heart transplant recipients experienced greater risk for SARS-CoV-2 infection, related hospitalization and death compared with those who were vaccinated, according to a brief report published in JAMA Cardiology.
“The FDA issued an emergency use authorization for a messenger RNA (mRNA) vaccine against COVID-19 on Dec. 11, 2020,” Laura L. Peters, DNP, FNP, advanced heart failure and cardiac transplant nurse practitioner and assistant professor in medicine-cardiology at University of Colorado Hospital, and colleagues wrote. “Transplant recipients were excluded from the initial safety studies of COVID-19 vaccines, and there was concern that transplant recipients may have suboptimal immunogenicity due to immunosuppression.”
Prior studies in JAMA and The Journal of Heart and Lung Transplantation reported that approximately 14% to 17% of solid organ transplant recipients who received mRNA COVID-19 vaccines had an antibody response after the first dose, and 48% to 51% had an antibody response after the second dose.
“Although the study did report that COVID-19 vaccines appear to be safe in transplant recipients, the implications of only partial antibody response to vaccination toward protection from COVID-19-related morbidity and mortality remain unknown,” the researchers wrote. “Therefore, we sought to assess the safety and effectiveness of COVID-19 vaccination in a large cohort of orthotopic heart transplant recipients.”
Researchers conducted the present case-control study using data from a single U.S. center. The analysis included 436 adult recipients of an orthotopic heart transplant (mean age, 54 years; 70% men) who were followed up from Jan. 15, 2021, to Jan. 31, 2022.
The primary outcome was COVID-19, related hospitalizations, ICU admissions and deaths among vaccinated compared with unvaccinated heart transplant recipients.
A total of 366 heart transplant recipients were vaccinated, of whom 19.7% experienced COVID-19, 4.1% were hospitalized, 1.1% were admitted to the ICU and 0.8% died.
Among the 70 heart transplant recipients who were unvaccinated, 48.6% experienced COVID-19, 14.3% were hospitalized, 4.3% were admitted to the ICU and 4.3% died.
Researchers reported that COVID-19 vaccination among patients who received a heart transplant was associated with lower risk for infection (RR = 0.41; 95% CI, 0.3-0.56), COVID-19-related hospitalization (RR = 0.29; 95% CI, 0.14-0.61) and death (RR = 0.19; 95% CI, 0.05-0.82) compared with non-vaccination.
Six months after vaccination, researchers observed no changes in mean left ventricular ejection fraction, LV wall thickness and B-type natriuretic peptide levels.
Moreover, among patients who experienced COVID-19 infection even after vaccination, mean LVEF, LV wall thickness and BNP levels remained unchanged compared with baseline, pre-vaccination measures.
There were no cases of rejection or allosensitization, according to the researchers.
“Despite theoretical safety concerns for vaccination resulting in immune activation and subsequent organ rejection or myocarditis, we found no evidence of allograft dysfunction, clinically significant rejection or allosensitization in this large cohort of vaccinated patients with orthotopic heart transplant,” the researchers wrote. “The combination of these findings support professional society and individual transplant center recommendations that orthotopic heart transplant recipients receive COVID-19 vaccines.”
References:
- Boyarsky BJ, et al. JAMA. 2021;doi:10.1001/jama.2021.7489.
- Hallett AM, et al. J Heart Lung Transplant. 2021;doi:10.1016/j.healun.2021. 07.026.
Collapse