Humoral vaccine response and breakthrough infections in kidney transplant recipients during the COVID-19 pandemic: a nationwide cohort study.

Publication date: Jun 01, 2023

Kidney transplant recipients (KTRs) experienced reduced SARS-CoV-2 vaccine response and were at increased risk of severe COVID-19. It is unknown if level of vaccine induced anti-receptor binding domain IgG (anti-RBD IgG) correlates with protection from and survival following COVID-19. We aimed to evaluate the effect of vaccine response on risk of breakthrough infections (BTI) and COVID-19 death in KTRs. We performed a nationwide study, examining the competing risk of SARS-CoV-2 infection, COVID-19 related/unrelated death, and vaccine efficacy as assessed by level of anti-RBD IgG response 4-10 weeks after each vaccination. The study included all KTR in Norway alive and with a functioning graft on February 20th, 2020, and events after November 11th, 2022 were right-censored. A pre-pandemic reference-cohort from January 1st 2019 to January 1st 2020 was included to evaluate excess mortality. The study was conducted at Oslo University Hospital, Rikshospitalet, Norway. The study included 3607 KTRs (59 [48-70] years) with a functioning graft at February 20th, 2020, who received (median [IQR]) 4 [3-4] vaccines (range 2-6, 99% mRNA). Anti-RBD IgG was measured in 12 701 serum samples provided by 3213 KTRs. Vaccine response was assessed 41 [31-57] days after vaccination. A total of 1090 KTRs were infected with SARS-CoV-2, 1005 (92%) were BTI, and vaccine response did not protect against BTI. The hazard ratio for COVID-19 related death 40 days post-infection was 1. 71 (95% CI: 1. 14, 2. 56) comparing vaccine response levels (≥5 vs. ≥5000 BAU/mL). No excess non-COVID-19 mortality was registered in KTRs surviving SARS-CoV-2 infection compared to a 2019 pre-pandemic reference. Our findings suggested that SARS-CoV-2 mRNA vaccine response did not predict protection against infection, but prevention of fatal disease progression in KTRs and greater vaccine response further reduced the risk of COVID-19 death. No excess non-COVID-19 mortality was seen during the pandemic. CEPI and internal funds.

Open Access PDF

Concepts Keywords
Competing Anti-RBG IgG
Kidney COVID-19
Norway Immunosuppression
Vaccine Infectious disease
Kidney transplant recipients
Vaccine response


Type Source Name
disease VO vaccine
disease MESH breakthrough infections
disease MESH COVID-19 pandemic
disease MESH death
pathway REACTOME SARS-CoV-2 Infection
disease VO vaccine efficacy
disease VO vaccination
disease MESH infection
disease MESH disease progression
disease MESH Malignancies
disease MESH Infectious disease
drug DRUGBANK Coenzyme M
disease VO population
disease VO organ
disease MESH syndrome
disease MESH acute kidney injury
disease VO vaccine dose
disease IDO country
disease IDO symptom
disease IDO assay
disease VO vaccination dose
disease VO dose
disease MESH death causes
drug DRUGBANK Ilex paraguariensis leaf
disease VO effective
drug DRUGBANK Tacrolimus
drug DRUGBANK Mycophenolic acid
disease IDO immunosuppression
drug DRUGBANK Prednisolone
disease VO vaccinated
disease IDO history

Original Article

(Visited 1 times, 1 visits today)

Leave a Comment

Your email address will not be published. Required fields are marked *