ABSTRACT
BACKGROUND: Coronavirus disease 2019 (COVID-19) has had a major effect on kidney and other solid organ transplant recipients. Vaccination has emerged as a key tool for controlling the pandemic. Kidney transplant recipients (KTR) are highly vulnerable to the serious complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and thus stand to benefit from vaccination. Various studies reported varying responses to different COVID vaccines;however, most data is available for SARS-CoV-2 messenger RNA (mRNA) as compared to other vaccines. This study aims to assess the humoral immune response to replication defective viral vectors [ChAdOx1-nCOV (Covishield)] and whole inactivated one [BBV-152 (Covaxin)] that are currently being administered in India in post-renal transplant patients after the first and second dose. AIM OF THE STUDY: Primary: To study antibody response after ChAdOx1-nCOV (Covishield) and BBV-152 (Covaxin) in post-renal transplant recipients Secondary: To study occurrence of adverse events related to COVID vaccine within one week of vaccination METHODS: Anti-SARS-CoV-2 anti-spike antibody titers were measured in 285 KTR recipients at baseline prior to vaccination and then 3 weeks +/- 3 days after first dose and 3 weeks +/- 3 days after second dose of ChAdOx1-nCOV (Covishield) (n = 232) and BBV-152 (Covaxin) (n = 55) vaccine. Immune response was defined as seropositivity to the anti-spike antibody by chemiluminescence immunoassay method and chemiluminescent microparticle immunoassay. Primary outcome was seroconversion after two doses of COVAXIN TM and COVISHIELD TM. The secondary outcome studied was the occurrence of adverse events related to the COVID vaccine within one week of vaccination. Patients with a history of symptomatic COVID-19 infections were excluded from the study. RESULT(S): At baseline, 18 (33.3%) and 70 (30.3%) of KTRs were found to be seropositive before receiving COVAXIN TM and COVISHIELD TM vaccination respectively despite giving no history of previous symptomatic COVID-19 infection. After first dose of COVAXIN TM and COVISHIELD TM vaccination, 42 (77.8%) and 182 (78.8%) were found to be seropositive and after second dose 43 (79.6%) and 183 (79.2%) were seropositive respectively. Seroconversion was found in 81.2% of males compared to 66.7% of females after the first dose of Covid vaccine which was statistically significant (p = 0.022). Seroconversion rate in -50 years was 76.7% (232/285) and >50 years was 90.6% (53/285) (p = 0.025). Seroconversion was not statistically different in KTR whether they were ABO compatible or incompatible, type of induction agent or maintenance immunosuppression used. Common adverse effects encountered were fever, myalgia, headache which settled in 1-2 days. There was no episode of acute rejection reported after the COVID vaccine. CONCLUSION(S): Both ChAdOx1-nCOV (Covishield) and BBV- 152 (Covaxin) were well tolerated and induced robust antibody formation in KTRs in the Indian population.
ABSTRACT
Infections are major cause of morbidity and mortality after transplantation. Although many infections are common worldwide, there are differences in various geographic locations. South Asia and India, in particular, has a very active transplant program for kidney and liver transplantation, however, there are no guidelines as how to screen and provide prophylaxis to solid organ transplant (SOT) recipients and donors for both specific infections prevalent in this region along with usual infections. Keeping this in mind, a working group was created comprising transplant physicians, surgeons, and infectious disease specialists from South Asia as well as experts from other countries. This working group developed guidelines based on published evidence, unpublished data from large centers in this region, along with expert opinion. This section of the guidelines deals with pretransplant screening of donors and recipients, which should be useful in dealing with transplants performed in this region for patients belonging to these countries, for those coming for transplantation from other countries, and for programs outside of South Asia who are screening donors and recipients from this region or who have spent significant time in this region. Copyright © 2022 Indian Journal of Transplantation Published by Wolters Kluwer - Medknow.
ABSTRACT
Infections are common after solid organ transplantation (SOT) and are an important cause of significant morbidity and mortality. Many of these infections can be prevented or their severity reduced by vaccination in pre and posttransplantation period. It is better to complete the vaccination before transplantation as protection and seroconversion is better, and live vaccines are mostly contraindicated after SOT. Live vaccines should be given at least 4 weeks before transplantation but killed vaccines can be given up to 2 weeks before the planned transplantation. Vaccination for some diseases which are endemic in South Asia should be given, along with usual vaccinations. Serological monitoring is required for some vaccines to check their efficacy. Similarly, some vaccines are recommended for SOT recipients traveling to various endemic regions. Copyright © 2022 Indian Journal of Transplantation Published by Wolters Kluwer - Medknow.
ABSTRACT
Respiratory infections are among the most common and serious infections after solid organ transplantation (SOT). Infections within a month after transplant are usually donor-derived or bacterial infections related to surgical infections or ventilator associated. Infections between 1-6 months after SOT are mostly opportunistic due to various viruses, or fungal infections. After 6 months of transplantation usually community acquired infections predominate, however it is not uncommon to find opportunistic fungal and viral infections in this period. The signs and symptoms of these infections are often mitigated in SOT recipients, so a high index of suspicion is required along with microbiological or tissue diagnosis early in the course to timely treat these infections. Thorough screening for common infections and endemic infections is required in donor and recipients before transplantation to reduce the risk of infections in posttransplant period. Finally, a longer duration of treatment and prophylaxis is required for adequately treat these infections and prevent the relapse. Copyright © 2022 Indian Journal of Transplantation Published by Wolters Kluwer - Medknow.
ABSTRACT
INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has affected the care of patients with noncommunicable diseases, including those suffering from kidney-related ailments. Many parts of the world, including India, adopted lockdown to curb community transmission of disease. The lockdown affected transportation, access to health care facilities, and availability of medicines and consumables as well as outpatient and inpatient services. We aimed to analyze the effect of lockdown imposed due to the COVID-19 pandemic on the care of patients with kidney diseases in India. METHODS: We surveyed 19 major hospitals (8 in the public and 11 in the private sector) to determine the effect of lockdown on the care of patients with kidney disease, including those on dialysis after the first 3 weeks of lockdown. RESULTS: The total number of dialysis patients in these centers came down from 2517 to 2404. Approximately 710 (28.2%) patients missed 1 or more dialysis sessions, 69 (2.74%) required emergency dialysis sessions, 104 (4.13%) stopped reporting for dialysis, and 9 (0.36%) were confirmed to have died. Outpatient attendance in the surveyed hospital came down by 92.3%, and inpatient service reduced by 61%. Tele-consultation was started but was accessed by only a small number of patients. CONCLUSION: Lack of preparedness before lockdown resulted in an interruption in health care services and posed an immediate adverse effect on the outcome of dialysis patients and patients with kidney disease in India. The long-term impact on the health of patients with less severe forms of kidney disease remains unknown.