Impact of SARS-CoV-2 Infection on Humoral and Cellular Immunity in a Cohort of Vaccinated Solid Organ Transplant Recipients

The aim of the present study was to determine humoral and T-cell responses after four doses of mRNA-1273 vaccine in solid organ transplant (SOT) recipients, and to study predictors of immunogenicity, including the role of previous SARS-CoV-2 infection in immunity. Secondarily, safety was also assessed. Liver, heart, and kidney transplant recipients eligible for SARS-CoV-2 vaccination from three different institutions in Barcelona, Spain were included. IgM/IgG antibodies and T cell ELISpot against the S protein four weeks after receiving four consecutive booster doses of the vaccine were analyzed. One hundred and forty-three SOT recipients were included (41% liver, 38% heart, and 21% kidney). The median time from transplantation to vaccination was 6.6 years (SD 7.4). In total, 93% of the patients developed SARS-CoV-2 IgM/IgG antibodies and 94% S-ELISpot positivity. In total, 97% of recipients developed either humoral or cellular response (100% of liver recipients, 95% of heart recipients, and 88% of kidney recipients). Hypogammaglobulinemia was associated with the absence of SARS-CoV-2 IgG/IgM antibodies and S-ELISpot reactivity after vaccination, whereas past symptomatic SARS-CoV-2 infection was associated with SARS-CoV-2 IgG/IgM antibodies and S-ELISpot reactivity. Local and systemic side effects were generally mild or moderate, and no recipients experienced the development of de novo DSA or graft dysfunction following vaccination

Development and validation of the Neuro-Score: a specific scale to detect and monitor cognitive impairment in kidney or liver transplant recipients

We created and validated the Neuro-Score, a specific scale to detect and monitor cognitive impairment, including mild stages, in kidney or liver transplant recipients. A qualitative study was conducted to define a preliminary set of 62 items. Item reduction was performed using exploratory factor analysis. Confirmatory factor analysis assessed the adequacy of the factorial solution. The total scores of the Neuro-Score and mini-mental state examination were compared. Responsiveness to change was evaluated from visit 1 (baseline) to 2A (18 months later) and temporal stability from visit 2A to 2B (1-2 weeks later). Factor analysis showed 11 factors with an eigenvalue of >1. Confirmatory factor analysis yielded a logical solution with 1 factor and 11 items that explained 27.9% of the variance. The final model showed satisfactory internal consistency (Cronbach alpha- 0.82). A weak negative correlation was found between Neuro-Score and mini-mental state examination total scores (Pearson r--0.12; P-.0095). The Neuro-Score responsiveness to change was demonstrated (P-.022). No significant differences in the total score were observed between visits 2A and 2B, supporting the Neuro-Score temporal stability. The Neuro-Score scale is a simple, reliable, self-administered, easy-to-interpret, and consistent 11-item scale to detect and monitor cognitive impairment in kidney and liver transplant recipients