The Higher COVID-19 Fatality Rate Among Kidney Transplant Recipients Calls for Further Action

Medina‐Pestana, José Osmar; Cristelli, Marina Pontello; Foresto, Renato Demarchi; Tedesco‐Silva, Hélio; Requião-Moura, Lúcio R.

doi:10.1097/tp.0000000000004086

Cited by 19 publications

(24 citation statements)

References 19 publications

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“…Compared to the general population, solid organ transplant recipients may have increased morbidity and mortality from SARS‐CoV‐2 infection. 1 , 2 , 3 , 4 , 5 , 6 The introduction of the COVID‐19 vaccine has significantly reduced morbidity and mortality in the general population. 7 , 8 However, solid organ transplant recipients take immunosuppressive drugs which may alter their immune response to vaccines.…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of first, second, and third COVID-19 vaccine doses in solid organ transplant recipients: A population-based cohort study from Canada

Naylor

Kim

Smith

et al. 2022

American Journal of Transplantation

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Limited data exists on the effectiveness of a third COVID‐19 vaccine dose in solid organ transplant recipients. We conducted a population‐based cohort study using linked healthcare databases from Ontario, Canada to answer this question. We included solid organ transplant recipients ( n = 12,842) as of December 14, 2020, with follow‐up until November 28, 2021. We used an extended Cox proportional hazards model with vaccination status, including BNT162b2, mRNA‐1273, and ChAdOx1 vaccines, modeled as a time‐dependent exposure. Individuals started in the unvaccinated category (reference) and could contribute person‐time to first, second, and third doses. Over a median follow‐up of 349 days, 12.7% ( n = 1632) remained unvaccinated, 54.1% ( n = 6953) received 3 doses, and 488 (3.8%) tested positive for SARS‐CoV‐2 (of which 260 [53.3%] had a clinically important outcome [i.e., hospitalization or death]). Adjusted vaccine effectiveness against infection was 31% (95% CI: 2, 51%), 46% (95% CI: 21, 63%), and 72% (95% CI: 43, 86%) for one, two, and three doses. Vaccine effectiveness against clinically important outcomes was 38% (95% CI: 4, 61%), 54% (95% CI: 23, 73%), and 67% (95% CI: 11, 87%). Vaccine effectiveness in solid organ transplant recipients is lower than the general population, however, vaccine effectiveness improved following a third dose.

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Section: Introductionmentioning

confidence: 99%

“…Compared to the general population, solid organ transplant recipients may have increased morbidity and mortality from SARS‐CoV‐2 infection 1–6 . The introduction of the COVID‐19 vaccine has significantly reduced morbidity and mortality in the general population 7,8 .…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of first, second, and third COVID-19 vaccine doses in solid organ transplant recipients: A population-based cohort study from Canada

Naylor

Kim

Smith

et al. 2022

American Journal of Transplantation

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show abstract

“…Retrospective studies have provided a growing real-world experience, but there are many areas that remain to be investigated, to improve outcomes for SOT recipients. 9 Previously, 1 we contrasted the early pandemic (when hydroxychloroquine, azithromycin, and lopinavir-ritonavir were used) with the more recent period (when remdesivir and dexamethasone became prominent). Inpatient therapies have also included anti-inflammatory agents such as tocilizumab and baricitinib, 3 and convalescent plasma was often used in the early pandemic.…”

Section: Introductionmentioning

confidence: 99%

“…Retrospective studies have provided a growing real-world experience, but there are many areas that remain to be investigated, to improve outcomes for SOT recipients. 9 …”

Section: Introductionmentioning

confidence: 99%

Update on COVID-19 Therapeutics for Solid Organ Transplant Recipients, Including the Omicron Surge

Avery

2022

Transplantation

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Major changes have occurred in therapeutics for coronavirus-19 (COVID-19) infection over the past 12–18 mo, most notably in early outpatient therapy. In most cases, solid organ transplant recipients were not included in the original clinical trials of these agents, so studies of real-world outcomes have been important in building our understanding of their utility. This review examines what is known about clinical outcomes in solid organ transplant recipients with newer therapies. SARS-CoV-2 monoclonal antibodies for early treatment or prophylaxis have likely prevented many hospitalizations and deaths. In addition, convalescent plasma, the oral drugs nirmatrelvir/ritonavir and molnupiravir, remdesivir for early outpatient treatment, anti-inflammatory therapy, and investigational virus-specific T-cell therapy will be discussed. Finally, the later consequences of COVID-19, such as secondary infections, long COVID symptoms, and persistent active infection, are identified as areas for future research.

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“… 3 , 4 , 7 Thus, it seemed reasonable to apply additional doses of vaccine to achieve immunization in transplanted patients, who are at higher risk for coronavirus disease 2019 (COVID-19)–related mortality. 8 …”

Section: Introductionmentioning

confidence: 99%

Immunogenicity After a Heterologous BNT262b2 Versus Homologous Booster in Kidney Transplant Recipients Receiving 2 Doses of CoronaVac Vaccine: A Prospective Cohort Study

et al. 2022

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Background. Comparative studies of third heterologous doses following the CoronaVac vaccine against coronavirus disease 2019 (COVID-19) in kidney transplant recipients are lacking. Methods. This prospective, single-center cohort study included kidney transplant recipients without previous COVID-19. Patients received a third heterologous (BNT162b2 mRNA) or homologous dose at least 4 wk after 2 doses of the CoronaVac vaccine. Immunoglobulin G antibody response and seroprevalence for neutralizing anti-severe acute respiratory syndrome coronavirus 2 antibodies immediately before and 28 d after third doses were compared between the groups. Results. There were 307 patients in the heterologous group and 777 in the homologous group. Patients in the heterologous group were older (54 versus 50 y; P < 0.0001), with a longer time since transplant (11 versus 6 y; P < 0.0001). Immediately before the third dose, immunoglobulin G seroprevalence (36% versus 34%; P = 0.597) and antibody titers (246 versus 268 AU/mL; P = 0.279) were similar. After booster, seroconversion was higher in the heterologous group (49% versus 32%; P < 0.0001), resulting in a higher seroprevalence (67% versus 55%; P = 0.0003); however, 42% of all patients remained seronegative. Antibody titers after booster in seropositive patients were higher in the heterologous group (7771 versus 599 AU/mL; P < 0.0001). These results persisted after adjusting for confounding variables. Lastly, a similar proportion of patients became seropositive for neutralizing antibodies (98% versus 94%; P = 0.098). Conclusions. In kidney transplant recipients fully vaccinated with CoronaVac, a third dose with an mRNA vaccine produced a higher seroconversion rate and antibody titers than a third homologous dose. However, both boosters achieved equivalent seroprevalence for neutralizing antibodies. The high proportion of still seronegative patients indicates the need for alternative strategies of protection.

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The Higher COVID-19 Fatality Rate Among Kidney Transplant Recipients Calls for Further Action

Cited by 19 publications

References 19 publications

Effectiveness of first, second, and third COVID-19 vaccine doses in solid organ transplant recipients: A population-based cohort study from Canada

Effectiveness of first, second, and third COVID-19 vaccine doses in solid organ transplant recipients: A population-based cohort study from Canada

Update on COVID-19 Therapeutics for Solid Organ Transplant Recipients, Including the Omicron Surge

Immunogenicity After a Heterologous BNT262b2 Versus Homologous Booster in Kidney Transplant Recipients Receiving 2 Doses of CoronaVac Vaccine: A Prospective Cohort Study

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