Safety of the First Dose of SARS-CoV-2 Vaccination in Solid Organ Transplant Recipients

Boyarsky, Brian J.; Ou, Michael T.; Greenberg, Ross S.; Teles, Aura T.; Werbel, William A; Avery, Robin K.; Massie, Allan B.; Segev, Dorry L.; Garonzik-Wang, Jacqueline

doi:10.1097/tp.0000000000003654

Cited by 68 publications

(74 citation statements)

References 5 publications

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“…Of note, a recent study into COVID-19 vaccine response in 187 solid organ transplant recipients-half of whom had the BNT162b2 vaccine-did not report any episodes of acute rejection. 23 Little is known about the biodistribution of lipid nanoparticles, a factor which may be relevant in the two patients reported since tissue trafficking of the mRNA would determine whether the cells and tissues in the eye are killed by cytotoxic T cells. Given the rapid uptake of vaccine proteins throughout the body, it would be anticipated that any significant upregulation of the immune response due to RNA-driven protein expression would occur within the first weeks, as seen in published data from completed trials, allowing us to promptly identify if rejection might occur at increased rates after vaccination.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of endothelial corneal transplant rejection following immunisation with SARS-CoV-2 messenger RNA vaccine

2021

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AimWe report two cases of endothelial corneal allograft rejection following immunisation with SARS-CoV-2 messenger RNA (mRNA) vaccine BNT162b2 and describe the implications for management of transplant recipients postvaccination for COVID-19.MethodsA 66-year-old woman with Fuchs endothelial corneal dystrophy (FECD) and a unilateral Descemet’s membrane endothelial keratoplasty (DMEK) transplant received COVID-19 mRNA vaccine BNT162b2 14 days post-transplant. Seven days later, she presented with symptoms and signs of endothelial graft rejection. An 83-year-old woman with bilateral DMEK transplants for FECD 3 and 6 years earlier developed simultaneous acute endothelial rejection in both eyes, 3 weeks post second dose of COVID-19 mRNA vaccine BNT162b2. Rejection in both cases was treated successfully with topical corticosteroids.ConclusionsWe believe this is the first report of temporal association between corneal transplant rejection following immunisation against COVID-19 and the first report of DMEK rejection following any immunisation. We hypothesise that the allogeneic response may have been initiated by the host antibody response following vaccination. Clinicians and patients should be aware of the potential of corneal graft rejection associated with vaccine administration and may wish to consider vaccination in advance of planned non-urgent keratoplasties. Patients should be counselled on the symptoms and signs that require urgent review to allow early treatment of any confirmed rejection episode.

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Section: Discussionmentioning

confidence: 99%

Characteristics of endothelial corneal transplant rejection following immunisation with SARS-CoV-2 messenger RNA vaccine

2021

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“…The rate of systemic events was slightly higher than reported in solid organ transplant recipients on immunosuppression who underwent early vaccination. 5 Strengths of this study includea national sample and novel, early data to inform major concerns among patients and their providers. Limitations include a relatively small, non-randomised sample, lack of longer-term safety data and a less granular ascertainment of side effects than the original trials.…”

mentioning

confidence: 99%

Safety of the first dose of mRNA SARS-CoV-2 vaccines in patients with rheumatic and musculoskeletal diseases

Connolly

Ruddy²,

Boyarsky³

et al. 2021

Ann Rheum Dis

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Transplantation and Immunology Research Network of the American Society of Transplantation (Werbel). The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products or organisations imply endorsement by the US Government. Competing interests None declared. Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research. Patient consent for publication Not required. Provenance and peer review Not commissioned; externally peer reviewed. This article is made freely available for use in accordance with BMJ's website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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“…Happily, as more transplant patients went on to be vaccinated, early theoretical concerns of activation of the immune system by the vaccine, triggering episodes of rejection, have not been observed. 4 Thankfully, I got my tests done 1 month after the second dose of the vaccine, and all was good with my kidney transplant. However, questions still remain about the efficacy of the vaccine in immunosuppressed patients like me.…”

Section: Covid-19 Vaccines In People With Transplantsmentioning

confidence: 99%

“…[7][8][9] The second part of the Hopkins study showed slightly more promise after the second dose of the vaccine. 4 We still need more clinical data, but how quickly will it arrive?…”

Section: A Call For Research Shared Decision-making and Empowering Patients With Knowledgementioning

confidence: 99%

Getting the COVID-19 vaccine as a transplant patient

Mittelman

2021

BMJ EBM

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Safety of the First Dose of SARS-CoV-2 Vaccination in Solid Organ Transplant Recipients

Abstract: Severe: prevents daily activity. d More than baseline. SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.

Cited by 68 publications

References 5 publications

Characteristics of endothelial corneal transplant rejection following immunisation with SARS-CoV-2 messenger RNA vaccine

Characteristics of endothelial corneal transplant rejection following immunisation with SARS-CoV-2 messenger RNA vaccine

Safety of the first dose of mRNA SARS-CoV-2 vaccines in patients with rheumatic and musculoskeletal diseases

Getting the COVID-19 vaccine as a transplant patient

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Safety of the First Dose of SARS-CoV-2 Vaccination in Solid Organ Transplant Recipients

Abstract: Severe: prevents daily activity. d More than baseline. SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.

Cited by 68 publications

References 5 publications

Characteristics of endothelial corneal transplant rejection following immunisation with SARS-CoV-2 messenger RNA vaccine

Characteristics of endothelial corneal transplant rejection following immunisation with SARS-CoV-2 messenger RNA vaccine

Safety of the first dose of mRNA SARS-CoV-2 vaccines in patients with rheumatic and musculoskeletal diseases

Getting the COVID-19 vaccine as a transplant patient

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Product

Resources

About

Safety of the first dose of mRNA SARS-CoV-2 vaccines in patients with rheumatic and musculoskeletal diseases