key: cord-0691670-rmo6a87b
authors: Montagud-Marrahi, Enrique; Cucchiari, David; Cuadrado-Payán, Elena; Cofan, Frederic; Torregrosa, Josep-Vicens; Ventura-Aguiar, Pedro; Revuelta, Ignacio; Bodro, Marta; Piñeiro, Gaston J.; Esforzado, Nuria; Campistol, Josep M.; Oppenheimer, Federico; Marcos, M. Ángeles; Bayés, Beatriu; Moreno, Asunción; Diekmann, Fritz
title: SARS-CoV-2 Infection After Full Vaccination in Kidney Transplant Recipients
date: 2021-08-16
journal: Transplantation
DOI: 10.1097/tp.0000000000003927
sha: 51decbc5bb996c04247bef11350378fd90ff1e83
doc_id: 691670
cord_uid: rmo6a87b

nan

S ince the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), several vaccines have been developed and approved for human use in the United States and Europe. 1 In our center, coronavirus disease 2019 (COVID-19) vaccination of kidney transplant recipients (KTRs) started in February 2021, with about 800 KTRs fully vaccinated in May 2021. Among the different vaccines, mRNA vaccines BNT162b2 (Pfizer/BioNTech) and mRNA-1273 (Moderna) have demonstrated an effectiveness of up to 95% in preventing COVID-19 in immunocompetent population. However, the effectiveness in KTRs to induce an immunological response has been reported to be significantly lower (up to 65%), and information about the risk and severity of a postvaccination COVID-19 is scarce in these patients. [1] [2] [3] [4] [5] [6] Herein, we describe 21 cases of KTRs (20 KTRs and 1 simultaneous pancreas-kidney recipient) who developed a polymerase chain reaction-proven COVID-19 after a full vaccination course. The study was approved by the ethics committee from our center. 

Cellular and humoral immune responses after three doses of BNT162b2 mRNA SARS-Cov-2 vaccine in kidney transplant

Cellular and humoral response after MRNA-1273 SARS-CoV-2 vaccine in kidney transplant recipients

Breakthrough COVID-19 infections after mRNA vaccination in solid organ transplant recipients in Miami

Two doses of SARS-CoV-2 vaccines reduce risk of death due to COVID-19 in solid organ transplant recipients: preliminary outcomes from a UK registry linkage analysis

Development of COVID-19 infection in transplant recipients after SARS-CoV-2 vaccination

Risk of breakthrough SARS-CoV-2 infections in adult transplant recipients

From the 21 KTRs, 2 patients (9%) received a 2-dose regimen of the BNT162b2 vaccine and 19 (91%) the mRNA-1273 vaccine. Only 1 patient (5%) developed SARS-CoV-2 immunoglobulin G antibodies after vaccination (which were assessed >15 d after the second dose). All patients were diagnosed with COVID-19 through a nasopharyngeal swab after a mean time of 84.71 ± 27.43 d from the second vaccine dose (52% with pneumonia). SARS-CoV-2 variants could be determined in 5 patients: 2 patients were infected with the Alpha variant and 3 with the Delta one. Table 1 summarizes demographic, transplantation immunosuppression, and COVID-19 characteristics of the analyzed patients. Two patients (9%) were asymptomatic.Regarding patient management, 11 patients (52%) required hospital admission, and 7 (33%) required intensive care unit (ICU) admission with the need for mechanical ventilation in 6. Ten (48%) were managed as outpatients ( Table 1) . Of the 21 patients, 1 (5%) died, 7 (33%) are still admitted (5 of them in the ICU), and 13 (62%) have been already discharged. Current median hospital stay is 11 (7-20) d.With this letter, we would like to provide preliminary information about a single-center kidney transplant population in Spain after a full COVID-19 vaccination regimen and reinforce the apparently less efficient immunization effect that COVID-19 vaccines provide in KTRs and the need to vaccinate their close relatives, as well as to still maintain precautions against COVID-19 in this population (especially against the Delta variant), even after full vaccination course. Nevertheless, actual hospital and ICU admission rates are lower compared with a nonvaccinated cohort of KTRs (79% and 52% for hospital and ICU admission, respectively) from our center. Larger studies are needed to provide robust information on the prognosis and management of KTRs with COVID-19 after vaccination, as well as the potential need for a third dose to increase the immunization rate.