Benefits of Inactivated Vaccine and Viral Vector Vaccine Immunization on COVID-19 Infection in Kidney Transplant Recipients

Abstract

The coronavirus virus disease 2019 (COVID-19) pandemic has impacted the global healthcare system. In Thailand, the first and most available vaccines were inactivated and viral vector vaccines. We reported the impact of those vaccines in preventing severe disease and death in kidney transplant recipients. This retrospective study comprised 45 kidney transplant recipients with COVID-19 infection, classified by vaccination status. Outcomes of interest were death, pneumonia, and allograft dysfunction. There were 23 patients in vaccinated group and 22 patients in unvaccinated group. All baseline characteristics were similar except mean age was older in vaccinated group, 55 vs. 48 years. Total 11 patients (24%) died (13% vaccinated vs. 36% unvaccinated RR, 0.56; 95% CI, 0.29–0.83; p = 0.03). Multivariate analysis showed that vaccination significantly decrease mortality (odds ratio, 0.54; 95% CI, 0.10–0.94; p = 0.03). Pneumonia developed equally in both groups (70%). There was a trend toward less oxygen requirement as well as ventilator requirement in vaccinated group. The rate of allograft dysfunction was similar (47%). Inactivated and viral vector COVID-19 vaccines have beneficial effect on mortality reduction in kidney transplant recipients. Even partial vaccination can exert some protection against death. However, full vaccination should be encouraged to achieve better prevention.

The Effect of a Booster Dose mRNA Vaccine on COVID-19 Infection in Kidney Transplant Recipients after Inactivated or Viral Vector Vaccine Immunization

“…SARS-CoV-2 infection had a very high mortality rate among KTRs, particularly those who did not receive any vaccines. Previous studies reported a mortality rate of 20–37% in KTRs who did not receive any vaccines [ 21 , 32 , 33 ]. Two doses of vaccination in KTRs reduced the mortality rate to 10–20% [ 19 , 21 , 34 ], however, there was some breakthrough infection in this setting and the rate of pneumonia were still high, at 50–70% [ 19 , 21 , 34 , 35 ].…”

“…Previous studies reported a mortality rate of 20–37% in KTRs who did not receive any vaccines [ 21 , 32 , 33 ]. Two doses of vaccination in KTRs reduced the mortality rate to 10–20% [ 19 , 21 , 34 ], however, there was some breakthrough infection in this setting and the rate of pneumonia were still high, at 50–70% [ 19 , 21 , 34 , 35 ]. Breakthrough infection rates in KTRs receiving two doses of vaccination were reported to be around 0.4 to 1.5% [ 34 , 36 ], but this incidence was 20 to 80 times higher than that in the general population [ 37 ].…”

“…Breakthrough infection rates in KTRs receiving two doses of vaccination were reported to be around 0.4 to 1.5% [ 34 , 36 ], but this incidence was 20 to 80 times higher than that in the general population [ 37 ]. The outcome following breakthrough infection was poor, with around a 10 to 20% mortality rate [ 19 , 21 , 34 ].…”

“…By 6 months, antibody level was too low to prevent infection and breakthrough infection can occur. KTRs can develop severe disease, with a 50–70% incidence of pneumonia and a 20–25% mortality rate during breakthrough infection [ 19 , 20 , 21 ]. A booster dose of the vaccination was used to increase antibody levels with the hope that it would reduce incidence and severity of breakthrough infection.…”

Immunogenicity of SARS-CoV-2 Vaccine in Kidney Transplant Recipients: A Cross-Sectional Study in Korea

“…Solid organ transplant recipients have a 30% or greater risk of ventilation or death when infected with SARS-CoV-2 compared to a transplant naïve population, with a hospital admission rate over 50–80% and intensive care unit admission rate of 30%. 5 6 7 8 …”