Occurrence of Severe SARS-CoV-2 Infection in Fully Vaccinated Solid Organ Transplant Recipients

Abstract

The present study presents the clinical outcome of SARS-COV-2 disease in relation to the humoral response in fully vaccinated Solid Organ Transplant (SOT) recipients. Our patient cohort consists of 455 SOT recipients, vaccinated with one of the two approved mRNA vaccines. The antibody response was measured one month after the second dose and previously infected patients has been excluded. Of the 449 remaining patients, 15 (3.34%) tested positive, using SARS-COV-2 PCR. Mean age of them was 43.7 ±14.4 years and median time from transplantation was 7.8 years (1.2- 30.2). 11 patients (73.3%) had been vaccinated with BNT162b2 and 4 (26.7%) with the mRNA1273 vaccine. At the time of infection 9 (60%) patients had a negative (<50AU/ml) antibody titer, while 6 (40%) a positive one (>50AU/ml). Median antibody titer, 27.4± 14.0 days after the second dose, measured at 13AU/ml (0-7480AU/ml). Renal function did not appear to be affected by the disease. Τhe mean eGFR at diagnosis was 48 ± 15 ml/min, when in a 29(1-101) day median follow-up was 53.9± 20.9ml/min. Of the 15 patients, 7 had mild symptoms, and were not hospitalized, while of the remaining 8 (53.3%) who needed hospitalization, 7 had severe disease and 2 of them expired. The study confirms the variable and often severe course of COVID-19 infection in SOT recipients, even after their full vaccination, highlighting the need to vaccinate their close relatives and to accelerate the implementation of the booster dose of vaccine.

COVID-19 in solid organ transplant recipients after 2 years of pandemic: Outcome and impact of antiviral treatments in a single-center study

“…Multivariate regression analysis for severe COVID-19 in SOTs.These data are in agreement to what has been reported in the study conducted by Marinaki et al(30), underlining the importance of the booster dose and the need to vaccinate this category of patients with multiple doses(31,32).In our study, the use of Mycophenolate was a risk factor for the development of a severe form of COVID-19 [OR for Mycophenolate-based vs. other non-mycophenolate-based regimens: 1.8, 95, CI: (1.3-2.1) severe COVID-19 vs. mildmoderate COVID-19; p = 0.039], while the presence of Everolimus in the immunosuppressive regimen represented a protective factor against severe COVID-19 [OR for Everolimusbased vs. other non-everolimus-based regimens: 0.7, 95, CI: (0.5-0.8) severe COVID-19 vs. mild-moderate COVID-19; p = 0.031]. Regarding the use of mycophenolate, our data confirmed what was reported by Colmenero et al and Requião-Moura (33, 34).…”

Immunogenicity, Safety, and Breakthrough Severe Acute Respiratory Syndrome Coronavirus 2 Infections After Coronavirus Disease 2019 Vaccination in Organ Transplant Recipients: A Prospective Multicenter Canadian Study

“…Hall et al [ 45 ] found that disease severity in medically attended SOT who had breakthrough infection after 1 or 2 doses of vaccination was similar to unvaccinated SOT recipients. In a large SOT cohort of patients who received 2 doses of vaccine, breakthrough was seen in 3.34% with 53% developing severe disease [ 46 ]. Hamm et al [ 47 ] found that receiving 3 vaccine doses decreased the risk of hospital admission by 58%.…”

Reduction in the risk of progression of solid organ transplant recipients infected by SARS-CoV-2 treated with monoclonal antibodies

“…The evidence of whether effective anti-SARS-CoV-2 vaccines may significantly reduce the risk of morbidity and mortality-associated with COVID-19 in SOT recipients is unclear [ 33 ]. Relevant studies assessed in this block included a retrospective registry-based analysis [ 34 ], a cohort study [ 35 ], a retrospective multicenter study [ 36 ], an observational data linkage cohort analysis [ 37 ], and a population-based cohort study [ 38 ].…”

“…A cohort study of 449 SOT patients vaccinated with one of the two approved mRNA vaccines at the moment of study (BNT162b2 and mRNA-1273), observed severe course of COVID-19 was common in a small number of SOT recipients (n=15) who tested positive for COVID-19 even after their full vaccination (two doses of mRNA vaccine at the moment of the study) [ 35 ]. Fifteen patients (3.3%) tested positive using SARS-CoV-2 PCR, with negative antibody titers in 9 (60%) of them.…”