According to preliminary data, seroconversion after mRNA SARS‐CoV‐2 vaccination might be unsatisfactory in Kidney Transplant Recipients (KTRs). However, it is unknown if seronegative patients develop at least a cellular response that could offer a certain grade of protection against SARS‐CoV‐2. To answer this question, we prospectively studied 148 recipients of either kidney (133) or kidney‐pancreas (15) grafts with assessment of IgM/IgG spike (S) antibodies and ELISpot against the nucleocapside (N) and the S protein at baseline and 2 weeks after receiving the second dose of the mRNA‐1273 (Moderna) vaccine. At baseline, 31 patients (20.9%) had either IgM/IgG or ELISpot positivity and were considered to be SARS‐CoV‐2‐pre‐immunized, while 117 (79.1%) patients had no signs of either cellular or humoral response and were considered SARS‐CoV‐2‐naïve. After vaccination, naïve patients who developed either humoral or cellular response were finally 65.0%, of which 29.9% developed either IgG or IgM and 35.0% S‐ELISpot positivity. Factors associated with vaccine unresponsiveness were diabetes and treatment with antithymocytes globulins during the last year. Side effects were consistent with that of the pivotal trial and no DSAs developed after vaccination. In conclusion, mRNA‐1273 SARS‐CoV‐2 vaccine elicits either cellular or humoral response in almost two thirds of KTRs.

Recently published studies have found an impaired immune response after SARS‐CoV‐2 vaccination in solid organ recipients. However, most of these studies have not assessed immune cellular responses in liver and heart transplant recipients. We prospectively studied heart and liver transplant recipients eligible for SARS‐CoV‐2 vaccination. Patients with past history of SARS‐CoV‐2 infection or SARS‐CoV‐2 detectable antibodies (IgM or IgG) were excluded. We assessed IgM/IgG antibodies and ELISpot against the S protein 4 weeks after receiving the second dose of the mRNA‐1273 (Moderna) vaccine. Side effects, troponin I, liver tests and anti‐HLA donor‐specific antibodies (DSA) were also assessed. A total of 58 liver and 46 heart recipients received two doses of mRNA‐1273 vaccine. Median time from transplantation to vaccination was 5.4 years (IQR 0.3–27). Sixty‐four percent of the patients developed SARS‐CoV‐2 IgM/IgG antibodies and 79% S‐ELISpot positivity. Ninety percent of recipients developed either humoral or cellular response (87% in heart recipients and 93% in liver recipients). Factors associated with vaccine unresponsiveness were hypogammaglobulinemia and vaccination during the first year after transplantation. Local and systemic side effects were mild or moderate, and none presented DSA or graft dysfunction after vaccination. Ninety percent of our patients did develop humoral or cellular responses to mRNA‐1273 vaccine. Factors associated with vaccine unresponsiveness were hypogammaglobulinemia and vaccination during the first year after transplantation, highlighting the need to further protect these patients.

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A national outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in December 2019 in Wuhan, China, rapidly evolving to the coronavirus disease 2019 (COVID-19) pandemic. Neurologic complications of COVID-19 include headache, confusion, hyposmia, and dysgeusia, 1 with encephalitis being rarely reported. Coronaviruses can potentially invade the CNS through trans-synaptic propagation via nasal entry, likely causing hyposmia. Alternatively, CNS dysfunction may result from the systemic hyperinflammatory response to the virus. We report 2 patients supporting this hypothesis. Patient 1A 25-year-old healthy man presented with 1-day history of headache, left-sided paresthesias, and ipsilateral paresis progressing within 12 hours to confusion and agitation. His axillary temperature was 38.2°C. Brain CT and MRI scans were normal. CSF showed lymphocytic pleocytosis and increased proteins. He was started on IV acyclovir, ampicillin, and ceftriaxone, which were discontinued when CSF cultures and PCR ruled bacterial or viral etiologies. PCR of SARS-CoV-2 was negative in CSF but positive in the nasopharyngeal swab. On day 2, he fully recovered except for amnesia of the previous 2 days.