key: cord-1040309-gk1w0g6o authors: Caillard, Sophie; Chavarot, Nathalie; Bertrand, Dominique; Kamar, Nassim; Thaunat, Olivier; Moal, Valerie; Masset, Christophe; Hazzan, Marc; Gatault, Philippe; Sicard, Antoine; Chemouny, Jonathan M.; Rerolle, Jean Philippe; Colosio, Charlotte; Francois, Hélène; Bamoulid, Jamal; Bouvier, Nicolas; Duveau, Agnès; Anglicheau, Dany; Blancho, Gilles title: Occurrence of severe COVID-19 in vaccinated transplant patients date: 2021-05-23 journal: Kidney Int DOI: 10.1016/j.kint.2021.05.011 sha: bdbd15a8285143db8bba62faab68554a3e17072e doc_id: 1040309 cord_uid: gk1w0g6o nan Occurrence of severe COVID-19 in vaccinated transplant patients Q1 To the editor: Vaccination plays a paramount role in the current coronavirus disease 2019 (COVID-19) pandemic response. Although mRNA-based vaccines elicit a strong immune response in the general population, the immunization rates of immunocompromised patients-including solid organ transplant recipients-have not been specifically investigated in mRNA-1273 and BNT162b2 pivotal trials. 1, 2 This knowledge gap should be addressed urgently, as these patients are highly prone to developing severe COVID-19. Here, we describe a total of 55 solid organ transplant recipients (52 kidney and 3 simultaneous kidney-pancreas) who developed COVID-19 after receiving 2 doses of mRNAbased severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) vaccines. A total of 9 and 46 patients received the mRNA-1273 (Moderna) and the BNT162b2 (Pfizer-Bio-NTech) vaccine, respectively. The study sample included 32 men and 23 women (median age: 60 years, interquartile range: 49À67 years; mean time from transplantation: 66 months, interquartile range: 33À138 months). Six patients were treated with belatacept, and one with rituximab. COVID-19 symptoms appeared after a median of 22 days after the second vaccine dose (interquartile range: 13À36 days; Figure 1 ). Of the 55 patients, 15 (27%) required hospitalization for oxygen therapy. Of these, 6 were admitted to an intensive care unit, and 3 died. Among the 25 patients with available data on anti-SARS-CoV-2 antibodies between the second vaccine dose and the onset of COVID-19 symptoms, 24 had negative serology, and one had positive results with weak antibodies levels (577 AU/L on the day of the second injection; Architect Abbot test). SARS-CoV-2 sequencing, which was performed in 24 cases, revealed 5 wild-type viruses, 17 UK variants, one Marseille variant, and one B 1.160 variant. Growing evidence indicates that solid organ transplant recipients who receive mRNA-based vaccines have low immunization rates, with <50% of patients showing antibodies against the SARS-CoV-2 spike protein. 3, 4 Although immunosuppressive drugs are thought to play a key role in this phenomenon, the occurrence of severe COVID-19 after mRNA-based vaccination in immunocompetent or immunocompromised subjects has not yet been reported. A potential explanation for persisting disease susceptibility may lie in an absent humoral response, coupled with a limited or insufficient T-cell response, even after the second vaccine dose. Vulnerable immunocompromised patients who are nonresponsive to mRNA-based SARS-CoV-2 vaccines should undergo close serologic follow-up and/or maintain strict sanitary protection measures. Other management strategies may include priority vaccination of the patients' households and the development of more-effective vaccination schemes. 6 20 31 40 21 3 32 18 7 14 15 4 4 36 27 27 30 79 60 13 54 31 51 52 61 3 15 18 6 5 17 43 52 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine Low immunization rates among kidney transplant recipients who received 2 doses of the mRNA-1273 SARS-CoV-2 vaccine Immunogenicity of a single dose of SARS-CoV-2 messenger RNA vaccine in solid organ transplant recipients