In Brief | Transplant Medicine & Infectious Diseases
Vaccination: RSV Vaccination Generates Strong Antibody Responses but Reduced Cellular Immunity in High-Risk Transplant Recipients
[30 June 2026]
Study Snapshot
| Design | Observational immunogenicity study |
| Population | 197 immunocompromised patients (46 kidney transplant, 30 lung transplant, 19 CKD) plus 52 immunocompetent controls |
| Comparison | RSV-specific antibody (ELISA) and T-cell (flow cytometry) responses pre- and post-vaccination, compared across transplant types and time since transplant |
| Primary Outcome | Significant increase in RSV-specific antibodies and polyfunctional CD4 T-cells post-vaccination (P<0.0001); weaker T-cell responses in lung transplant recipients (P=0.023) and within 1 year post-transplant (P=0.005); no CD8 response induced |
Summary
Respiratory syncytial virus (RSV) causes significant morbidity in solid organ transplant (SOT) recipients, who face elevated risk of severe lower respiratory tract infection, hospitalisation, and death. Although RSVpreF-based vaccines are now recommended for high-risk groups, data on vaccine-induced immunity in transplant recipients have remained limited, particularly for cellular responses.
This observational study assessed baseline RSV immunity and vaccine responses in 197 immunocompromised patients — including 46 kidney and 30 lung transplant recipients, and 19 patients with chronic kidney disease — alongside 52 immunocompetent controls, all receiving a single protein-based RSV vaccine dose.
Most participants showed evidence of prior RSV exposure, with over 90% RSV-specific IgG positive and 30–58% having detectable RSV-specific CD4 T-cell responses at baseline. Vaccination produced a significant rise in RSV-specific antibodies and polyfunctional CD4 T-cell responses, with cross-reactivity against both RSV-A and RSV-B. However, lung transplant recipients showed significantly weaker T-cell responses than kidney transplant recipients, and SOT recipients vaccinated within the first year post-transplant had reduced cellular responses; no CD8 T-cell response was induced in any group.
These findings indicate that while RSV vaccination is broadly immunogenic in SOT recipients, lung transplant recipients and those early post-transplant may need alternative or adjunctive vaccination strategies.
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