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Effect of a Fourth Dose of mRNA Vaccine and of Immunosuppression in Preventing SARS-CoV-2 Breakthrough Infections in Heart Transplant Patients

Authors :
Marco Masetti
Maria Francesca Scuppa
Alessio Aloisio
Laura Giovannini
Laura Borgese
Stefania Manno
Beatrice Tazza
Renato Pascale
Cecilia Bonazzetti
Natascia Caroccia
Mario Sabatino
Giosafat Spitaleri
Pierluigi Viale
Maddalena Giannella
Luciano Potena
Source :
Microorganisms, Vol 11, Iss 3, p 755 (2023)
Publication Year :
2023
Publisher :
MDPI AG, 2023.

Abstract

Patients with heart transplantation (HT) have an increased risk of COVID-19 disease and the efficacy of vaccines on antibody induction is lower, even after three or four doses. The aim of our study was to assess the efficacy of four doses on infections and their interplay with immunosuppression. We included in this retrospective study all adult HT patients (12/21–11/22) without prior infection receiving a third or fourth dose of mRNA vaccine. The endpoints were infections and the combined incidence of ICU hospitalizations/death after the last dose (6-month survival rate). Among 268 patients, 62 had an infection, and 27.3% received four doses. Following multivariate analysis, three vs. four doses, mycophenolate (MMF) therapy, and HT < 5 years were associated with an increased risk of infection. MMF ≥ 2000 mg/day independently predicted infection, together with the other variables, and was associated with ICU hospitalization/death. Patients on MMF had lower levels of anti-RBD antibodies, and a positive antibody response after the third dose was associated with a lower probability of infection. In HT patients, a fourth dose of vaccine against SARS-CoV-2 reduces the risk of infection at six months. Mycophenolate, particularly at high doses, reduces the clinical effectiveness of the fourth dose and the antibody response to the vaccine.

Details

Language :
English
ISSN :
11030755 and 20762607
Volume :
11
Issue :
3
Database :
Directory of Open Access Journals
Journal :
Microorganisms
Publication Type :
Academic Journal
Accession number :
edsdoj.47e6bf2a3ba74467a0a0d810de7c5eb6
Document Type :
article
Full Text :
https://doi.org/10.3390/microorganisms11030755