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Breakthrough Infections Following mRNA SARS-CoV-2 Vaccination in Kidney Transplant Recipients
Auxiliadora Mazuecos1, Florentino Villanego1, Sofía Zarraga2
1Department of Nephrology, Hospital Universitario Puerta del Mar, Cádiz, Spain.
Transplantation
|April 6, 2022
Summary
COVID-19 vaccination effectiveness is lower in kidney transplant recipients. While overall mortality did not differ between vaccinated and unvaccinated groups, mRNA-1273 showed better outcomes than BNT162b2 in breakthrough infections.
Area of Science:
- Nephrology
- Immunology
- Infectious Diseases
Background:
- Kidney transplant (KT) recipients exhibit reduced clinical effectiveness of coronavirus disease 2019 (COVID-19) vaccination compared to the general population.
- Severity of COVID-19 in KT patients remains high, even after two mRNA vaccine doses.
Purpose of the Study:
- To compare the outcomes of COVID-19 in vaccinated versus unvaccinated kidney transplant recipients.
- To evaluate the effectiveness of different mRNA vaccines in kidney transplant recipients.
Main Methods:
- Analysis of 481 KT recipients with COVID-19 from April to October 2021, using data from the Spanish Society of Nephrology COVID-19 Registry.
- Comparison of outcomes between unvaccinated/partially vaccinated (n=130) and fully vaccinated (n=351) patients.
- Multivariable analysis to identify risk factors for mortality.
Main Results:
- No significant difference in mortality between fully vaccinated (21.7%) and unvaccinated/partially vaccinated (20.8%) KT recipients (P = 0.776).
- Age and pneumonia were independent risk factors for death; vaccination status was not associated with mortality.
- mRNA-1273 vaccine demonstrated significantly lower mortality compared to BNT162b2 vaccine in KT recipients with breakthrough infections (HR: 0.52; P = 0.010).
Conclusions:
- COVID-19 severity has not improved in kidney transplant recipients despite two mRNA vaccine doses.
- The mRNA-1273 vaccine shows higher clinical effectiveness than BNT162b2 in KT recipients experiencing breakthrough infections.
- Further research is needed to confirm these findings, considering new variants and booster doses.
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