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. 2022 Jul 1;106(7):1430-1439.
doi: 10.1097/TP.0000000000004119. Epub 2022 Apr 1.

Breakthrough Infections Following mRNA SARS-CoV-2 Vaccination in Kidney Transplant Recipients

Auxiliadora Mazuecos  1 , Florentino Villanego  1 , Sofía Zarraga  2 , Verónica López  3 , Federico Oppenheimer  4 , Laura Llinàs-Mallol  5 , Ana M Hernández  6 , Alba Rivas  7 , María C Ruiz-Fuentes  8 , Néstor G Toapanta  9 , Carlos Jiménez  10 , Sheila Cabello  11 , Isabel Beneyto  12 , María J Aladrén  13 , Alberto Rodríguez-Benot  14 , Cristina Canal  15 , María Molina  16 , Isabel Pérez-Flores  17 , Isabel M Saura  18 , Eva Gavela  19 , Antonio Franco  20 , Inmaculada Lorenzo  21 , Cristina Galeano  22 , Guadalupe Tabernero  23 , Lourdes Pérez-Tamajón  24 , Paloma L Martín-Moreno  25 , Fernando Fernández-Girón  26 , Orlando Siverio  27 , Pedro J Labrador  28 , Gabriel De Arriba  29 , Fernando Simal  30 , Leónidas Cruzado  31 , Inigo Moina  32 , Guillermo Alcalde  33 , Emilio Sánchez-Álvarez  34 , Julio Pascual  5   6 , Marta Crespo  5 ; Spanish Society of Nephrology COVID-19 Group
Affiliations

Breakthrough Infections Following mRNA SARS-CoV-2 Vaccination in Kidney Transplant Recipients

Auxiliadora Mazuecos et al. Transplantation. .

Abstract

Background: The clinical effectiveness of coronavirus disease 2019 (COVID-19) vaccination in kidney transplant (KT) recipients is lower than in the general population.

Methods: From April to October 2021, 481 KT recipients with COVID-19, included in the Spanish Society of Nephrology COVID-19 Registry, were analyzed. Data regarding vaccination status and vaccine type were collected, and outcomes of unvaccinated or partially vaccinated patients (n = 130) were compared with fully vaccinated patients (n = 351).

Results: Clinical picture was similar and survival analysis showed no differences between groups: 21.7% of fully vaccinated patients and 20.8% of unvaccinated or partially vaccinated died (P = 0.776). In multivariable analysis, age and pneumonia were independent risk factors for death, whereas vaccination status was not related to mortality. These results remained similar when we excluded patients with partial vaccination, as well as when we analyzed exclusively hospitalized patients. Patients vaccinated with mRNA-1273 (n = 213) showed a significantly lower mortality than those who received the BNT162b2 vaccine (n = 121) (hazard ratio: 0.52; 95% confidence interval, 0.31-0.85; P = 0.010).

Conclusions: COVID-19 severity in KT patients has remained high and has not improved despite receiving 2 doses of the mRNA vaccine. The mRNA-1273 vaccine shows higher clinical effectiveness than BNT162b2 in KT recipients with breakthrough infections. Confirmation of these data will require further research taking into account the new variants and the administration of successive vaccine doses.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

None
Graphical abstract
FIGURE 1.
FIGURE 1.
Distribution of COVID-19 cases in KT recipients and COVID-19 rate in Spain during the study period. COVID-19, coronavirus disease 2019; KT, kidney transplant; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
FIGURE 2.
FIGURE 2.
Survival function for COVID-19–related death according to vaccination status (A); only in hospitalized patients (B); and patients who received mRNA-1273 or BNT1622b vaccines (C). COVID-19, coronavirus disease 2019.
See this image and copyright information in PMC

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