How Vaccinations Changed the Outcome of COVID-19 Infections in Kidney Transplant Patients: Single-Center Experience

Abstract

Kidney transplant recipients are a vulnerable population at risk of a life-threatening COVID-19 infection with an incidence of death four-times higher than in the general population. The availability of mRNA COVID-19 vaccines has dramatically changed the fate of this infection also within this fragile population. Transplanted patients have an impaired immunological response also to mRNA vaccines. In March 2021, however, we started a vaccination campaign. These preliminary results show that both the incidence of death and of hospitalization dropped from 13% to 2.4% and from 45% to 12.5% compared to the previous outbreaks reported by our group. In univariate analysis, two variables were associated with an increased risk of hospitalization: older age and dyspnea (p = 0.023, p < 0.0001, respectively). In multivariate analysis, dyspnea (p < 0.0001) and mycophenolate therapy (p = 0.003) were independently associated with the risk of hospitalization. The association was even stronger when the two variables were combined (p < 0.0001). Vaccinations did not reduce the incidence of COVID-19 infections among our transplanted patients, but provided certain protection that was associated with a significantly better outcome for this infection.

Kinetics of humoral immune response and severity of infection after three doses of SARS-CoV-2 mRNA vaccine in a large cohort of kidney transplant recipients

“…Our data also showed that vaccine response in KTR-VACCs was strongly influenced by increased age, decreased renal function, antimetabolite maintenance therapy and time from transplantation. The importance of age in mRNA-vaccine response was also described by Grupper et al, who showed the influence of age on mRNA-vaccine response in dialysis patients regardless of chronic medical conditions [ 5 ] and Campise et al, who reported older age and dyspnea as variables associated with an increased risk of hospitalization [ 28 ]. Moreover, persistent but declining anti-SARS-CoV-2 humoral immunity six months after the three-dose vaccination schedule with BNT162b2 in healthy individuals was more pronounced among older people [ 29 ].…”