Evaluating clinical effectiveness of SARS‐CoV‐2 vaccine in solid organ transplant recipients: A propensity score matched analysis

Abstract

Background: Solid organ transplant recipients (SOTRs) are at disproportionate risk for severe Coronavirus Disease 2019 . Vaccination is a key preventative strategy but is associated with decreased humoral responses among SOTR.Whether dampened immune responses correlate with reduced clinical effectiveness is unclear. Our study was designed to evaluate the clinical effectiveness of SARS-CoV-2 vaccination in the early vaccine era. Methods: We conducted a retrospective cohort study comparing SARS-CoV-2 infection rates between SOTRs who received two doses of mRNA or one dose of Ad26.Cov2.S vaccine and those not fully vaccinated (partially vaccinated and unvaccinated). To evaluate clinical effectiveness of vaccine, cause-specific Cox regression model and modified Poisson regression model were built using the propensity scorematched cohort. Additionally, the clinical outcomes of COVID-19 of fully vaccinated and not fully vaccinated SOTR were compared.Results: Of 2705 SOTRs, 1668 were included in our final matched analysis, which showed a 73% reduction of SARS-CoV-2 infection and 76% reduction of all-causemortality among fully vaccinated patients. Thirty-nine SOTRs developed SARS-CoV-2 infection, including nine fully vaccinated and 30 not fully vaccinated. Among fully vaccinated patients, 22% had severe/critical COVID-19 and 0% mortality versus not fully vaccinated SOTRs, of whom 37% had severe/critical COVID-19 and 6.67% COVID-19-related mortality. Conclusion:In SOTRs, completion of primary vaccine series in the early vaccine era was associated with a significant reduction of COVID-19 and was protective against severe/critical disease and death. Further studies are needed to evaluate the clinical Abbreviations: COVID-19, coronavirus disease 2019; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; SOTRs, solid organ transplant recipients.

Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection among Kidney Transplant Recipients: A Large Single-Center Experience

“…However, the most important and striking fndings were the protective efects of COVID-19 vaccination for hospitalization, overall mortality, and COVID-19-related mortality in this cohort. Our fndings are consistent with previous studies of the protective efect of vaccination in SOTRs [14][15][16][17]. Tese fndings reiterate the importance of vaccination against COVID-19 in kidney transplant recipients.…”

SARS-CoV-2 Vaccination in Solid-Organ Transplant Recipients

“…Overall SOT vaccinated (with two doses of mRNA vaccine or one Ad26.Cov2.S dose) compared to unvaccinated SOT, the vaccine has shown to decrease COVID-19 incidence rate, risk of symptomatic COVID-19, critical disease and mortality [25,30,[44][45][46][47]. In contrast other studies reported that vaccination with one or two doses of m-RNA vaccine did not reduce risk of disease severity and death after SARS-CoV-2 infection in SOT recipients [48][49][50].…”

Outcomes of COVID-19 in kidney transplant recipients in the vaccination Era: A national multicenter cohort from Thailand

“…Previous studies have shown that KTR have an inferior immune response to SARS-CoV-2 vaccination compared to the general population, and booster doses are necessary to enhance immune response for protection against SARS-CoV-2 infection and its severe complications [ 4 , 11 ]. However, the real-world efficacy of booster vaccinations in KTR, especially in Eastern countries with differing vaccine distribution and socioeconomic factors from Western countries, still require more data [ 9 , [11] , [12] , [13] , [14] , 36 ].…”

“…At present, most of the information about COVID-19 outcomes in KTR comes from Western countries [ [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] ]. This leaves a notable gap in knowledge about Asian KTR, where a wider variety of vaccine types, including inactivated, viral vector, and mRNA vaccines, have been used.…”