Comparison of outcomes in vaccinated versus unvaccinated COVID‐19 kidney transplant recipients, a single center retrospective study—Is the taboo justified?

Abstract

IntroductionWe assessed differences in the post‐transplant outcomes between COVID‐19 vaccinated and unvaccinated Kidney transplant (KTx) recipients.MethodsWe conducted a retrospective, single‐center study of 400 KTx from 2/1/2021 to 4/30/2022 with 6–21 months follow‐up. Primary outcomes included differences in the incidence of post‐transplant COVID‐19, ICU admission for COVID‐19, death, and graft failure between the two groups. Secondary outcomes were inpatient floor admission, outpatient‐management, length of hospital stay during COVID‐19 admission. We also reported rejection, DGF, CMV needing treatment, and BK PCR >10 000 in baseline characteristics.Result70.5% (282/400) were fully vaccinated, and 29.5% (118/400) were unvaccinated. 33% (92/282) of vaccinated and 39% (46/118) of unvaccinated patients developed COVID‐19 (p‐value .03). In both groups, 16% received outpatient treatments for COVID‐19. 3% (12/282) of the vaccinated and 8% (11/118) unvaccinated were admitted to the general floors (p‐value .06), and 1% (3/282) of the vaccinated and 3.3% (4/118) of the unvaccinated patients needed admission to the ICU (p‐value .2). The length of stay was 12 days in both groups. 13/282 (4.6%) vaccinated patients and 7/118 (5.93%) unvaccinated patients died during the follow‐up period (p‐value = .3). COVID‐19 was deemed the etiology of death in 5/13 cases in the vaccinated and 3/7 in the unvaccinated. DGF, rejection, CMV requiring treatment, and BK PCR >10 000 were comparable between groups.ConclusionThe incidence of COVID‐19 was higher in unvaccinated than in vaccinated KTx. The two groups were not statistically different for other primary outcomes, including the need for hospital admissions (outpatient, general floor, ICU), length of hospital stay, death, and graft failure.

Long-term follow-up of kidney transplant recipients admitted to a tertiary care transplant center with SARS-CoV-2

“…One study of 2500 KTRs found that the number of SARS-CoV-2 vaccination doses was inversely correlated with mortality, hospitalization, ICU admission, and acute kidney injury (AKI)[ 5 ]. On the other hand, a single-center study of 400 KTRs found no statistically significant differences between unvaccinated and vaccinated KTRs in terms of hospitalization (outpatient, general floor, ICU), length of stay, death, and graft failure[ 6 ]. It is important to note that in the study which noted a significant influence in vaccination on outcomes that it analyzed results according to the different SARS-CoV-2 variants, namely pre and post Omicron.…”

“…A single-center cohort study of 2500 KTRs found that vaccinated patients had improved outcomes concerning mortality, hospitalization, and intensive care unit (ICU) admission[ 5 ]. In another single-center study of 400 KTRs that compared unvaccinated and vaccinated recipients, there were no significant differences in the rates of ICU admission, length of hospital stay, death, or graft failure, although the incidence of SARS-CoV-2 infection was higher in the unvaccinated group[ 6 ]. Another study found that the severity of COVID-19 disease necessitating the hospitalization of KTRs was predominantly influenced by comorbid conditions and baseline kidney function [baseline estimated glomerular filtration rate (eGFR)]; however, they found that when adjusted for comorbidity and renal function, they found no statistically significant differences in mortality, ICU admission, and length of stay between adults hospitalized for COVID-19 who had undergone kidney transplant and non-transplanted counterparts[ 7 ].…”