Differences in clinical outcomes of COVID-19 among vaccinated and unvaccinated kidney transplant recipients

Demir, Erol; Dheir, Hamad; Şafak, Seda; Artan, Ayşe Serra; Sipahi, Savaş; Türkmen, Aydın

doi:10.1016/j.vaccine.2022.04.066

Cited by 11 publications

(17 citation statements)

References 16 publications

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“…Likewise, we previously found that COVID-19 mortality during the Delta surge among vaccinated OTRs after 2 mRNA vaccine doses or 1 dose of an adenoviral vector vaccine was comparable to that of unvaccinated controls, including controls from the pre-Delta phase [ 7 ]. The above findings were consistent with 2 more studies conducted during the Delta wave, which did not show a mortality benefit from vaccination [ 6 , 9 ].…”

Section: Discussionsupporting

confidence: 91%

“…In some studies of OTRs, vaccination with 2 doses of an mRNA vaccine was not associated with lower risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection [ 2 , 4 ], critical COVID-19 [ 4 , 5 ], or mortality [ 4 , 6 , 7 ]. However, others have found that vaccination decreased the risk of symptomatic illness [ 8 ], hospitalization [ 9 ], use of mechanical ventilation or extracorporeal membrane oxygenation (ECMO) support [ 10 ], and death [ 10 , 11 ].…”

mentioning

confidence: 99%

“…For example, one study of vaccinated OTRs during the Omicron surge showed that seronegativity was not associated with risk of breakthrough SARS-CoV-2 infection, which, nonetheless, decreased with increasing antispike antibody titers [ 23 ]. Importantly, most of the aforementioned studies spanned earlier phases of the pandemic [ 2 , 4 , 6 , 9 , 11 ], with different circulating variants and potentially standards of care, which can affect base mortality rates [ 24 , 25 ].…”

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confidence: 99%

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mRNA Vaccination Decreases COVID-19-Associated Morbidity and Mortality Among Organ Transplant Recipients: A Contemporary Cohort Study

Lerner

Arvanitis

Vieira

et al. 2022

Open Forum Infectious Diseases

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Background Organ transplant recipients (OTR) are less protected from vaccination than immunocompetent hosts. Additional vaccine doses have shown increased immunogenicity. Few studies assessed their clinical efficacy, particularly against Omicron variants, since most included patients from earlier phases of the pandemic, with higher base mortality rates. Methods We studied adult OTR who had COVID-19 between 12/15/21 and 5/25/22. We compared clinical outcomes between those who had received 2 or ≥3 doses of an mRNA vaccine and concurrent unvaccinated controls. Results Among 103 OTR, vaccination was associated with lower 90-day mortality (unvaccinated vs. 2 vs. ≥3 doses: 25% vs. 7% vs. 3%, P = 0.003), hospital (unvaccinated vs. 2 vs. ≥3 doses: 56% vs. 37% vs. 27%, P = 0.018) or ICU (unvaccinated vs. 2 vs. ≥3 doses: 25% vs. 15% vs. 3%, P = 0.001) admission rates, and peak O2 requirements (ordinal scale Kendall’s tau b=-0.309 [lower scores, i.e., O2 requirements with more vaccine doses], P = 0.003). Age (>60 years adjusted hazard ratio [aHR] 7.73, P = 0.016), administration of anti-spike monoclonal antibody (aHR 0.17, P = 0.042) and vaccination, especially with ≥3 doses (aHR 0.105, P = 0.01), were independently associated with 90-day mortality. Black (P = 0.021) or Hispanic (P = 0.016) OTR were underrepresented among the vaccinated, especially in the ≥3 dose group. Conclusions Despite lower mRNA vaccine efficacy in OTR and against Omicron variants, vaccination protects this vulnerable patient population from severe COVID-19 and death. Ethnic and racial disparities in healthcare have been exacerbated by the COVID-19 pandemic and warrant better community outreach efforts.

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Section: Discussionsupporting

confidence: 91%

mentioning

confidence: 99%

mentioning

confidence: 99%

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mRNA Vaccination Decreases COVID-19-Associated Morbidity and Mortality Among Organ Transplant Recipients: A Contemporary Cohort Study

Lerner

Arvanitis

Vieira

et al. 2022

Open Forum Infectious Diseases

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“…(d) Vaccine Several studies have documented that in KTx patients the seroconversion is low in comparison to healthy controls after two doses of several different types of vaccines with an inactivated virus and of mRNA vaccines [57][58][59]. A recent casecontrolled study [60] confirmed these data. The authors highlighted that this low efficacy is related to immunosuppression, and even by increasing the two doses to a third booster dose, COVID-19 remains a fatal disease despite different treatment modalities.…”

Section: Prophylaxismentioning

confidence: 86%

COVID-19 and Kidney Transplantation: Epidemiology, Histopathological Presentation, Clinical Presentation and Outcomes, and Therapeutic Strategies

Salvadori¹,

Tsalouchos

2022

Transplantology

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Multiple case series of kidney transplant recipients with COVID-19 have shown increased mortality compared to nontransplant patients. To date, we do not have high-level evidence to inform immunosuppression minimization strategies in infected transplant recipients. Most centers, however, have adopted an early antimetabolite withdrawal in addition to other interventions. The epidemiological problem concerns also dialysis patients and waitlisted patients who have a higher COVID-19 infection diffusion with respect to kidney transplant recipients. Several factors influence mortality among kidney transplant recipients. Among these factors are the age, race, and comorbidity factors, such as hypertension, diabetes mellitus, obesity, and previous respiratory problems. Treatment is still limited. The only effective antiviral drug is remdesivir that should be administered before the development of the cytokine storm. Vaccination seems to be useful, but due to the concomitant immunosuppression limiting its efficacy, at least three or four doses should be administered.

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“…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 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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The mortality rate after novel coronavirus infection, which causes severe acute respiratory distress syndrome (SARS-CoV-2), is much higher in kidney transplant recipients (KTRs) compared to the general population. Seroconversion after vaccination is also lower, and breakthrough infection is much higher. Many studies reported seroconversion rate after a booster (third) dose of vaccine but clinical outcomes received less attention. Here, we reported the impact of an mRNA vaccine booster dose on clinical outcomes of KTRs with SARS-CoV-2 infection. A total of 183 KTRs with SARS-CoV-2 infection were identified. Of 183 KTRs, 146 KTRs had sufficient data for analysis and were included in this study. Forty-eight patients (32.9%) received zero to 1 doses of vaccine (Group 1), thirty-one (21.2%) received two doses (Group 2), and sixty-seven (45.9%) received a booster dose (Group 3). Pneumonia developed in 50%, 23%, and 10% in Group 1, 2, and 3 (p < 0.001). Hospital admission requirement was 81%, 48%, and 12% (p < 0.001). Mortality rate was 26%, 3%, and 3% (p = 0.001). A multivariate analysis showed that only diabetes adversely affects mortality while the booster dose of the vaccine significantly reduced mortality. The booster dose of the vaccine is strongly recommended in all KTRs especially those with diabetes. Our study also suggested the timing of the booster dose vaccine to be administered within 4 months after the second dose.

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Differences in clinical outcomes of COVID-19 among vaccinated and unvaccinated kidney transplant recipients

Cited by 11 publications

References 16 publications

mRNA Vaccination Decreases COVID-19-Associated Morbidity and Mortality Among Organ Transplant Recipients: A Contemporary Cohort Study

mRNA Vaccination Decreases COVID-19-Associated Morbidity and Mortality Among Organ Transplant Recipients: A Contemporary Cohort Study

COVID-19 and Kidney Transplantation: Epidemiology, Histopathological Presentation, Clinical Presentation and Outcomes, and Therapeutic Strategies

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

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