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Using machine learning to predict antibody response to SARS-CoV-2 vaccination in solid organ transplant recipients: the multicentre ORCHESTRA cohort.

Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases

Authors: Maddalena Giannella, Manuel Huth, Elda Righi, Jan Hasenauer, Lorenzo Marconi, Angelina Konnova, Akshita Gupta, An Hotterbeekx, Matilda Berkell, Zaira R Palacios-Baena, Maria Cristina Morelli, Mariarosa Tamè, Marco Busutti, Luciano Potena, Elena Salvaterra, Giuseppe Feltrin, Gino Gerosa, Lucrezia Furian, Patrizia Burra, Salvatore Piano, Umberto Cillo, Mara Cananzi, Monica Loy, Gianluigi Zaza, Francesco Onorati, Amedeo Carraro, Fiorella Gastaldon, Maurizio Nordio, Samir Kumar-Singh, Jesús Rodríguez Baño, Tiziana Lazzarotto, Pierluigi Viale, Evelina Tacconelli

OBJECTIVES: The study aim was to assess predictors of negative antibody response (AbR) in solid organ transplant (SOT) recipients after the first booster of SARS-CoV-2 vaccination.

METHODS: Solid organ transplant recipients receiving SARS-CoV-2 vaccination were prospectively enrolled (March 2021-January 2022) at six hospitals in Italy and Spain. AbR was assessed at first dose (t), second dose (t), 3 ± 1 month (t), and 1 month after third dose (t). Negative AbR at t was defined as an anti-receptor binding domain titre <45 BAU/mL. Machine learning models were developed to predict the individual risk of negative (vs. positive) AbR using age, type of transplant, time between transplant and vaccination, immunosuppressive drugs, type of vaccine, and graft function as covariates, subsequently assessed using a validation cohort.

RESULTS: Overall, 1615 SOT recipients (1072 [66.3%] males; mean age±standard deviation [SD], 57.85 ± 13.77) were enrolled, and 1211 received three vaccination doses. Negative AbR rate decreased from 93.66% (886/946) to 21.90% (202/923) from t to t. Univariate analysis showed that older patients (mean age, 60.21 ± 11.51 vs. 58.11 ± 13.08), anti-metabolites (57.9% vs. 35.1%), steroids (52.9% vs. 38.5%), recent transplantation (<3 years) (17.8% vs. 2.3%), and kidney, heart, or lung compared with liver transplantation (25%, 31.8%, 30.4% vs. 5.5%) had a higher likelihood of negative AbR. Machine learning (ML) algorithms showing best prediction performance were logistic regression (precision-recall curve-PRAUC mean 0.37 [95%CI 0.36-0.39]) and k-Nearest Neighbours (PRAUC 0.36 [0.35-0.37]).

DISCUSSION: Almost a quarter of SOT recipients showed negative AbR after first booster dosage. Unfortunately, clinical information cannot efficiently predict negative AbR even with ML algorithms.

Copyright © 2023. Published by Elsevier Ltd.

PMID: 37150358

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