Efficacy of 3 COVID-19 vaccine doses in lung transplant recipients: a multicentre cohort study

Do three COVID-19 vaccine doses induce a serological response in lung transplant recipients?We retrospectively included 1071 adults (551 [52%] males) at nine transplant centres in France. Each had received three COVID-19 vaccine doses in 2021, after lung transplantation. An anti-spike protein IgG response, defined as a titre264 BAU·mLMedian follow-up after the first dose was 8.3 [6.7-9.3] months. A vaccine response developed in 173 (16%) patients. Factors independently associated with a response were younger age at vaccination, longer time from transplantation to vaccination, and absence of corticosteroid or mycophenolate therapy. After vaccination, 51 (5%) patients (47 non-responders [47/898, 5%] and 4 [4/173, 2%] responders) experienced COVID-19, at a median of 6.6 [5.1-7.3] months after the third dose. No responders had severe COVID-19, compared to 15 non-responders, including six who died of the disease.Few lung transplant recipients achieved a serological response to three COVID-19 vaccine doses, indicating a need for other protective measures. Older age and use of mycophenolate or corticosteroids were associated with absence of a response. The low incidence of COVID-19 might reflect vaccine protection