Renal Complications in Kidney Transplant Recipients After Whole-virus Inactivated COVID-19 Vaccination

Abstract

Despite the efficacy and safety of the COVID-19 vaccine in the general population, for solid organ transplants, there is a theoretical concern regarding vaccination-triggered immunologic complications. In fact, several rejection episodes have been reported after mRNA COVID-19 vaccination. 1,2 Contrary to mRNA vaccines that synthesize specific antigens to generate neutralizing antibody, wholevirus inactivated vaccines can activate the immunologic system more extensively as it used entire viral capsid. Additionally, new-onset and relapsed kidney pathological changes have been reported following COVID-19 vaccination in the general population, including minimal change disease, IgA nephrology, and membranous nephropathy. 3,4 Thus, we conducted a prospective study in kidney transplants (KTs) to evaluate the safety of whole-virus inactivated COVID-19 vaccine, especially renal graft complications. This study has been registered in Clinical Trials. gov (NCT04969614). Between September 1, 2021, and January 31, 2022, 290 kidney recipients received inactivated whole-virus COVID-19 vaccine (Table S1, SDC, http://links.lww.com/TP/C546), including BBIBP-CorV (Vero cell) and Coronavac (Vero cell). The median age was 41 y with 2 adolescents, and the majority were male. 278 received 2 doses of inactivated COVID-19 vaccine and 12 received 1 dose only. Among 290 patients, 56.9% received living-donor KT, 39.3% received antithymocyte immunoglobulin as the induction therapy and 97.6% received tacrolimus plus mycophenolic acid and steroids as the maintenance therapy. The median duration from transplantation to vaccination was 38 mo. During the last year, 5 patients received high-dose steroid pulse therapy, 2 received antithymocyte immunoglobulin, and 3 received rituximab because of rejection events.The median follow-up was 4.2 mo after vaccination. After vaccination, 11% patients experienced a serum creatinine increment >10% and 0.7% had an increment