Protecting kidney transplant recipients against SARS-CoV-2 infection: A third dose of vaccine is necessary now

Abstract

We have read the article written by Ison et al. 1 that has raised some issues we would like to discuss. COVID-19 breakthrough infection rates in vaccinated kidney transplant (KT) recipients much higher than in the general vaccinated population have been reported. 2 Furthermore, the severity remains markedly high. Although Ison et al. referred cases are rarely severe, other series, and among them, the largest cohort published so far, have reported 27% of very serious cases. 3 By August 2021, 843 KT recipients at our center have been fully vaccinated against COVID-19. During this period, 15 patients developed COVID-19 after two doses of mRNA-based vaccines: 1.8% versus 0.01% in the general population. 2 Of them, five needed hospitalization (33.3%): three remain in critical care units and one died. Contrary to what Ison et al. stated, also in our experience, severe COVID-19 has not been uncommon in infected vaccinated KT patients.

Immunogenicity and Risk Factors Associated With Poor Humoral Immune Response of SARS-CoV-2 Vaccines in Recipients of Solid Organ Transplant

“…After review, 105 articles were excluded owing to being a review article, case report, preprint, incorrect patient population, or duplicate cohort or having no outcomes of interest. A total of 83 studies 9 , 10 , 11 , 12 , 13 , 14 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 ...…”

“…The weighted mean (range) total seroconversion rate after 2 doses of mRNA COVID-19 vaccines was 44.9% (0%-79.1%) for antispike antibodies (53 studies 10 , 11 , 12 , 13 , 14 , 32 , 35 , 36 , 38 , 40 , 41 , 42 , 43 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 69 , 70 , 71 , 74 , 79 , 80 , 82 , 84 , 86 , 88 , 91 , 92 , 93 , 94 , 95 , 97 , 102 , 103 , 105 ) and 22.6% (0%-47.5%) for neutralizing antibodies (8 studies 12 , 49 , 62 , <...>…”

“…The pooled difference in means (SE) of 10 studies showed study participants with antibody response were 3.94 (1.1) years younger than those without antibody response ( P = .001) 45 , 46 , 47 , 49 , 53 , 56 , 59 , 63 , 66 , 103 ( Table ; eFigure 1 in the Supplement ). Male sex was associated with higher seroconversion rates (pOR, 1.16 [95% CI, 1.01-1.33]; P = .04; I 2 = 0%) (26 studies 32 , 45 , 46 , 47 , 49 , 50 , 53 , 56 , 57 , 59 , 62 , 63 , 64 , 66 , 70 , 74 , 79 , 80 , 82 , 84 , 86 , 88 , 92 , 93 , 94 , 103 ) ( Table , Figure 3 ; eFigure 1 in the Supplement ). Body mass index (BMI) and absolute lymphocyte count were not associated with differences in antibody response based on differences of means that were not statistically significant ( Table ; eFigure 1 in the Supplement ).…”

“…A total of 25 studies 32 , 45 , 46 , 49 , 50 , 53 , 56 , 57 , 59 , 62 , 63 , 64 , 66 , 70 , 74 , 79 , 80 , 82 , 88 , 91 , 92 , 93 , 94 , 95 , 103 reported on antimetabolite use at the time of vaccine administration, which was associated with lower seroconversion rates (pOR, 0.21 [95% CI, 0.14-0.29]; P < .001; I 2 = 70%) ( Table , Figure 3 ; eFigure 1 in the Supplement ). A total of 21 studies 10 , 32 , 45 , 46 , 49 , 50 , 53 , 56 , 57 , 62 , 63 , 64 , 66 , 70 , 74 , 80 , 82 , 84 , 88 , 93 , 103 reported active use of mammalian (mechanistic) target of rapamycin (mTOR) inhibitors, which was associated with higher seroconversion rates (pOR, 1.46 [95% CI, 1.02-2.08]; P = .04; I 2 = 42%) ( Table , Figure 3 ; eFigure...…”

Humoral Immune Response following SARS-CoV-2 Vaccination in Liver Transplant Recipients

“…It remains unclear how the humoral immune response as well as specific T-cell immunogenicity affect patients' actual protection from infection in the first place or from a severe course of disease, respectively. Villanego et al reported on a rate of 1.8% of completely vaccinated kidney transplant recipients developing a breakthrough infection and consecutively COVID-19 [6], whereas Aslam et al reported on an even lower rate of 4 out of 912 solid organ transplant recipients [7]. Malinis et al reported 0.65% of their fully vaccinated solid organ transplant recipients developed COVID-19 [8].…”