Preprint Brief Report Version 1 This version is not peer-reviewed

Mycophenolate Interruption Restores Anti-SARS-CoV-2 Vaccine Immunogenicity in Unresponsive Liver Transplant Recipients

Pierluigi Toniutto
* ORCID logo ,
Annarosa Cussigh
,
Sara Cmet
,
Martina Fabris
ORCID logo ,
Francesco Curcio
ORCID logo ,
Davide Bitetto
,
Ezio Fornasiere
,
Elisa Fumolo
,
Edmondo Falleti
Version 1 : Received: 18 May 2023 / Approved: 18 May 2023 / Online: 18 May 2023 (10:39:20 CEST)

How to cite: Toniutto, P.; Cussigh, A.; Cmet, S.; Fabris, M.; Curcio, F.; Bitetto, D.; Fornasiere, E.; Fumolo, E.; Falleti, E. Mycophenolate Interruption Restores Anti-SARS-CoV-2 Vaccine Immunogenicity in Unresponsive Liver Transplant Recipients. Preprints.org 2023, 2023051332. https://doi.org/10.20944/preprints202305.1332.v1 Toniutto, P.; Cussigh, A.; Cmet, S.; Fabris, M.; Curcio, F.; Bitetto, D.; Fornasiere, E.; Fumolo, E.; Falleti, E. Mycophenolate Interruption Restores Anti-SARS-CoV-2 Vaccine Immunogenicity in Unresponsive Liver Transplant Recipients. Preprints.org 2023, 2023051332. https://doi.org/10.20944/preprints202305.1332.v1

Abstract

Background & aims. The fourth dose of anti-SARS-CoV-2 vaccine slightly improved the humoral response among previously seronegative liver transplant (LT) recipients. Mycophenolate (MMF) treatment worsens the vaccination response. This study aimed to evaluate whether temporary MMF interruption might improve immunogenicity of the fourth anti-SARS-CoV-2 BNT16b2 vaccine dose in nonresponsive LT recipients. Methods. LT recipients negative for anti-spike glycoprotein-specific immunoglobulin G receptor-binding domain (s-RBD) antibodies after the third vaccine dose were enrolled. Anti-SARS-CoV-2 spike-specific T cell responses were measured before and two months following the fourth vaccine dose, and anti-SARS-CoV-2-s-RBD antibodies also 6 months thereafter. MMF was suspended two weeks before and after vaccination. Results. Five LT recipients were enrolled. After a mean of 78 days after vaccination, all patients tested positive for anti-SARS-CoV-2-s-RBD antibodies. The mean antibody titer was 8944 UI/ml. The positive antibody response was maintained during a mean of 193 days of follow-up. Three patients developed a positive T cell response. Two patients (one positive for T cell response) developed a self-limited SARS-CoV-2 infection. Conclusions. Suspending MMF prior to the fourth dose of anti-SARS-CoV-2 mRNA vaccine seems feasible and safe. This procedure could restore vaccine-induced immunogenicity in a large portion of previously nonresponsive LT recipients.

Keywords

Sars-CoV-2 infection; mycophenolate mofetil, liver transplantation, anti-SARS-CoV-2 vaccine.

Subject

Medicine and Pharmacology, Gastroenterology and Hepatology

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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