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