Case Report: Severe COVID-19 in a Kidney Transplant Recipient Without Humoral Response to SARS-CoV-2 mRNA Vaccine Series

Yamada, Masaaki; Matsumoto, Eiyu; Thomas, Christie P.; Carlson, Jennifer R; Klutts, J. Stacey; Kumar, Bharat; Streit, Judy A.; Swee, Melissa

doi:10.1097/txd.0000000000001193

Cited by 3 publications

(2 citation statements)

References 39 publications

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“…With increasing COVID-19 infections in the community, there is an opportunity to better understand the efficacy of the SARS-CoV-2 mRNA vaccine in KTRs in terms of infection rate and antibody response. There are new reports of break through infections following vaccination, 29 , 30 with Wadei et al 30 observing 7 COVID-19 positive SOTRs who received 1 or 2 doses of the mRNA vaccine. In this small cohort, none of the patients developed antibodies following vaccine administration.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors Associated With an Impaired Antibody Response in Kidney Transplant Recipients Following 2 Doses of the SARS-CoV-2 mRNA Vaccine

Moore

Eagar

et al. 2021

Transplantation Direct

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Background. Data about vaccine efficacy in solid organ transplant patients are limited. We previously reported our initial observation of a 6.2% immunogenicity rate in kidney transplant recipients (KTRs) after administration of 1 dose of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccine. We sought to report our observations of anti-SARS-CoV-2 antibody in KTRs after 2 doses of the SARS-CoV-2 mRNA vaccine. Methods. We identified 105 KTRs who received 2 doses of the Pfizer-BioNTech or Moderna mRNA-1273 vaccine per availability and had anti-SARS-CoV-2 labs obtained at least 2 wk following administration of the second dose. Antibody testing was performed using 3 clinically validated qualitative and semiquantitative assays. Results. KTRs had a 36.2% antibody response rate, whereas an age ≥68 years and a longer time from transplant were factors associated with antibody response. Conclusions. The low antibody response in KTRs may be associated with the immunosuppressive state. More data are needed to evaluate if KTRs may require higher vaccine doses or an additional booster dose to increase their ability to mount an immune response to the SARS-CoV-2 vaccine.

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Section: Discussionmentioning

confidence: 99%

Risk Factors Associated With an Impaired Antibody Response in Kidney Transplant Recipients Following 2 Doses of the SARS-CoV-2 mRNA Vaccine

Moore

Eagar

et al. 2021

Transplantation Direct

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“…The majority describe a clinical course without the need of CVVH or VV-ECMO treatment [3][4][5][6][7][8]. Furthermore, to the best of our knowledge, most case reports describing the course of COVID-19-associated ARDS and multiorgan failure in kidney transplant recipients either fail to report the long-term outcome [9] or report unsuccessful outcomes [10,11], most likely due to comorbidities and late diagnosis. What makes this case report unique is that it does not only describe a successful course of COVID-19-associated ARDS and multiorgan failure in a kidney transplant recipient; the patient also experienced complete renal and pulmonary recovery, despite several comorbidities and being especially vulnerable to infection in general.…”

Section: Discussionmentioning

confidence: 99%

Severe COVID-19 in a kidney transplant recipient with acquired hypogammaglobulinemia: A case report

Rivedal

Haaskjold

Guttormsen

et al. 2022

J Case Rep Images Med

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Introduction: Kidney transplant recipients have an increased risk of a severe clinical course and mortality due to coronavirus disease 2019 compared to that in the average population, and their treatment options are limited because reduced immunosuppression may lead to graft rejection. Herein, we describe a successful therapeutic regime in a kidney transplant recipient who suffered from coronavirus disease 2019-associated acute respiratory distress syndrome. Case Report: In this case report, we describe the course and management of a kidney transplant recipient who had severely reduced graft function (estimated glomerular filtration rate: 10–14 mL/min/1.73 m2) and acquired hypogammaglobulinemia and was consequently hospitalized and treated for severe coronavirus disease 2019. She presented with gastrointestinal symptoms, followed by increasing dyspnea, which rapidly progressed to acute respiratory distress syndrome. During hospitalization, she was treated under a ventilator (prone positioning) and with convalescent plasma, dexamethasone, careful monitoring of immunosuppression, continuous venovenous hemofiltration, and venovenous extracorporeal membrane oxygenation. Owing to successful treatment, the patient was discharged from the hospital after 74 days in a good condition and with a well-functioning kidney graft. Conclusion: Convalescent plasma, dexamethasone, monitoring of immunosuppression, continuous venovenous hemofiltration, and venovenous extracorporeal membrane oxygenation might be effective therapeutic options in kidney transplant recipients and other immunosuppressed patients with coronavirus disease 2019-associated acute respiratory distress syndrome.

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Risk Factors Associated With SARS-CoV-2 Breakthrough Infections in Fully mRNA-Vaccinated Individuals: Retrospective Analysis

Liu¹,

Lee²,

Ta³

et al. 2022

JMIR Public Health Surveill

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Background COVID-19 messenger RNA (mRNA) vaccines have demonstrated efficacy and effectiveness in preventing symptomatic COVID-19, while being relatively safe in trial studies. However, vaccine breakthrough infections have been reported. Objective This study aims to identify risk factors associated with COVID-19 breakthrough infections among fully mRNA-vaccinated individuals. Methods We conducted a series of observational retrospective analyses using the electronic health records (EHRs) of the Columbia University Irving Medical Center/New York Presbyterian (CUIMC/NYP) up to September 21, 2021. New York City (NYC) adult residences with at least 1 polymerase chain reaction (PCR) record were included in this analysis. Poisson regression was performed to assess the association between the breakthrough infection rate in vaccinated individuals and multiple risk factors—including vaccine brand, demographics, and underlying conditions—while adjusting for calendar month, prior number of visits, and observational days in the EHR. Results The overall estimated breakthrough infection rate was 0.16 (95% CI 0.14-0.18). Individuals who were vaccinated with Pfizer/BNT162b2 (incidence rate ratio [IRR] against Moderna/mRNA-1273=1.66, 95% CI 1.17-2.35) were male (IRR against female=1.47, 95% CI 1.11-1.94) and had compromised immune systems (IRR=1.48, 95% CI 1.09-2.00) were at the highest risk for breakthrough infections. Among all underlying conditions, those with primary immunodeficiency, a history of organ transplant, an active tumor, use of immunosuppressant medications, or Alzheimer disease were at the highest risk. Conclusions Although we found both mRNA vaccines were effective, Moderna/mRNA-1273 had a lower incidence rate of breakthrough infections. Immunocompromised and male individuals were among the highest risk groups experiencing breakthrough infections. Given the rapidly changing nature of the SARS-CoV-2 pandemic, continued monitoring and a generalizable analysis pipeline are warranted to inform quick updates on vaccine effectiveness in real time.

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Case Report: Severe COVID-19 in a Kidney Transplant Recipient Without Humoral Response to SARS-CoV-2 mRNA Vaccine Series

Abstract: Supplemental Digital Content is available in the text.

Cited by 3 publications

References 39 publications

Risk Factors Associated With an Impaired Antibody Response in Kidney Transplant Recipients Following 2 Doses of the SARS-CoV-2 mRNA Vaccine

Risk Factors Associated With an Impaired Antibody Response in Kidney Transplant Recipients Following 2 Doses of the SARS-CoV-2 mRNA Vaccine

Severe COVID-19 in a kidney transplant recipient with acquired hypogammaglobulinemia: A case report

Risk Factors Associated With SARS-CoV-2 Breakthrough Infections in Fully mRNA-Vaccinated Individuals: Retrospective Analysis

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