SARS‐CoV‐2 antibody testing for transplant recipients: A tool to personalize protection versus COVID‐19

Anti‐spike antibody testing has emerged as a powerful tool to assess SARS‐CoV‐2 vaccine response in solid organ transplant (SOT) recipients, many of whom remain at risk for COVID‐19 despite vaccination. Neither the US Food and Drug Administration nor major transplant societies recommend testing antibody responses after vaccination, or its general incorporation into COVID‐19 risk stratification. Notably, in December 2021, the American Society of Transplantation recognized anti‐spike seronegativity as a consideration for use of monoclonal antibody pre‐exposure prophylaxis. In this viewpoint, we narrate the evolving rationale for anti‐spike antibody testing and ultimately recommend that all SOT recipients be tested for anti‐spike antibody after vaccination. This result should then be used to personalize efforts to improve protection versus COVID‐19 for the most vulnerable, such as additional vaccination strategies and consideration of passive immunoprophylaxis. Anti‐spike antibody testing of solid organ transplant recipients after vaccination is a useful marker to assess vulnerability to COVID‐19. Fishman and Alter comments on page 1291