Is COVID Vaccine Associated with Development of De Novo Donor Specific Antibodies in Lung Transplant Recipients?

Purpose

There have been sporadic reports of de novo donor-specific antibody (DSA) development post-COVID vaccine, causing a significant impact on the graft. The study aims to determine if the COVID vaccine increases the incidence of de novo DSA and antibody-mediated rejection.

Methods

This is a single-center retrospective cohort study of lung transplant recipients who received two doses of COVID vaccine between 1/1/2021 and 7/31/2021. Presence of de novo DSA was checked before and after COVID vaccine. This study was IRB-approved. Baseline demographic data were extracted.

Results

One hundred and eighty-five patients had two doses of vaccine administered. The median age at transplant was 63 years. Male comprised 57% of the cohort. IPF was the primary listing diagnosis in 58% of the patients. Twenty patients (10%) developed a de novo DSA or had a rise in their existing antibody titer by more than 50% after the COVID Vaccine. Of these 20 patients, six patients (3.2% of entire cohort) developed de novo DSA. However, this was not statistically significant (McNemar's test, p = 0.288). One patient (0.5%) had considerable graft decline and required AMR treatment, despite which the graft function did not improve and now has chronic lung allograft dysfunction.

Conclusion

In our cohort, twenty patients (10%) developed a de novo DSA or had a rise in their existing antibody titer by more than 50% after the COVID Vaccine. Six patients (3.2% of entire cohort) developed de novo DSA. One patient (0.5%) had considerable graft decline and required AMR treatment. We did not notice a statistically significant de novo DSA development post COVID vaccine.