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1.
American Journal of Transplantation ; 22(Supplement 3):761, 2022.
Article in English | EMBASE | ID: covidwho-2063535

ABSTRACT

Purpose: The evidence regarding the clinical effectiveness of COVID-19 vaccination in kidney transplant (KT) recipients is limited so far. Our purpose is to analyze the characteristics and outcomes of a large series of KT with COVID-19 breakthrough infection and compare them with unvaccinated patients. As a secondary objective, we analyzed the evolution according to the type of mRNA vaccine administered. Method(s): From April to October 2021, KT recipients with COVID-19, included in the COVID-19 registry of the Spanish Society of Nephrology, were analyzed. Data regarding vaccination status and type of vaccine were collected and outcomes of unvaccinated or partially vaccinated patients were compared with fully vaccinated patients. Result(s): 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=.776). In multivariable analysis age and pneumonia were independent risk factors for death, while 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 (Moderna) (n=213) showed a significantly lower mortality than those who received BNT162b2 (Pfizer-BioNTech) vaccine (n=121) (16.4% vs. 28.8%, p=.002) (HR: 0.52, CI 95% 0.31-0.85, p=.010). Conclusion(s): COVID-19 severity in KT patients has remained high and has not improved despite receiving 2 doses of an mRNA vaccine, but the mRNA-1273 vaccine shows higher clinical effectiveness than BNT162b2 in KT recipients with breakthrough infection, so it could be considered as the first option in these patients.

2.
American Journal of Transplantation ; 22(Supplement 3):768, 2022.
Article in English | EMBASE | ID: covidwho-2063440

ABSTRACT

Purpose: Short-term adaptive immune memory has been reported among immunocompetent (IC) and convalescent Solid Organ Transplant (SOT) individuals following SARS-CoV-2 infection as well as after active vaccination. However, quality and longevity of anti-viral immune memory comparisons between natural and active immunization has not been thoroughly assessed among SOT. Method(s): SARS-CoV-2-specific adaptive immune memory was assessed at different compartments (serological, memory B cells [mBC] and cytokine [Th1: IFN-gamma, IL-2, IFN-gamma/IL-2 and Th2: IL-21 and IL-5] producing T cells) by ELISA and FluoroSpotbased assays, respectively, in 41 convalescent patients with severe COVID-19 (22 SOT and 19 IC) and 39 vaccinated patients (19 SOT and 20 IC) with a mRNA-based vaccine) at different time-points post immunization (T1=21days after infection/1st dose;T2=3months after infection/2nd dose;T3=6months after infection/2nd dose). Additionally, a group of convalescent mild (19 SOT and 19 IC) and asymptomatic patients (9 SOT and 10 IC) were also evaluated at T3. Result(s): Overall, statistically significant higher immune responses in all immune compartments were observed in convalescent patients than among those after vaccination. After vaccination, low seropositivity rates (5,88%) were observed among SOT after 1st dose, whereas seroconversion was fully achieved in IC patients and SOT with severe COVID-19 (p<0.001). Similarly, while the presence of mBc after vaccination progressively increased over time, it was less pronounced and significantly delayed among SOT than convalescent patients in all time points (p<0.001 T1, T2 and T3). SARS-CoV-2-specific Th1 and Th2 frequencies were significantly higher among vaccinated IC patients than SOT, being these responses significantly lower than those observed in convalescent among SOTT and IC patients (p<0.001 T1, T2 and T3). At 6 months after vaccination, IgG titers, mBc frequencies and Th1/ Th2 T-cell responses after two-dose vaccination in SOT mimicked those observed in convalescent SOT with an asymptomatic/mild clinical COVID-19 infection. Conclusion(s): The type of immunization against SARS-CoV-2, either natural or active after vaccination, clearly differentiates the quality and length of adaptive immune memory, with a clear weaker immune response observed among SOT.

3.
Nephrology Dialysis Transplantation ; 37(SUPPL 3):i745, 2022.
Article in English | EMBASE | ID: covidwho-1915805

ABSTRACT

BACKGROUND AND AIMS: COVID-19 in kidney transplants has a high risk of complications and mortality, especially in older recipients diagnosed during the early period after transplantation. Management of immunosuppression has been challenging during the pandemic. We investigated the impact of induction immunosuppression, either basiliximab or thymoglobulin, on the clinical evolution of kidney transplants developing COVID-19 during the early period after transplantation. METHOD: Kidney transplant recipients with <6 months with a functioning graft diagnosed of COVID-19 from the initial pandemic outbreak (March 2020) until 31 July 2021 from different Spanish centres participating in a nationwide registry. RESULTS: A total of 127 patients from 17 Spanish centres developed COVID-19 during the first 6 months after transplantation, 73 (57.5%) received basiliximab and 54 (42.5%) thymoglobulin. Demographics were not different between groups, but patients receiving thymoglobulin were more sensitized (cPRA of 32.7% ± 40.8% versus 5.6% ± 18.5%) and more frequently re-transplanted (30% versus 4%). Recipients older than 65 years treated with thymoglobulin showed the highest rate of acute respiratory distress syndrome [64.7% versus 37.1% for older recipients receiving thymoglobulin and basiliximab (P < .05), and 23.7% and 18.9% for young recipients receiving basiliximab and thymoglobulin (P > .05)] and the poorest survival [mortality rate of 64.7% and 42.9% for older recipients treated with thymoglobulin and basiliximab, respectively (P < .05), and 8.1% and 10.5% for young recipients treated with thymoglobulin and basiliximab (P > .05)]. Older recipients treated with thymoglobulin showed the poorest survival in the Cox's regression model adjusted for comorbidities. CONCLUSION: Thymoglobulin should be used with caution in older recipients during the present pandemic era.

4.
American Journal of Transplantation ; 21(SUPPL 4):313, 2021.
Article in English | EMBASE | ID: covidwho-1494427

ABSTRACT

Purpose: To better know the impact and characteristics of Covid-19 in renal patients, the Spanish Society of Nephrology set up a voluntary registry in March, 2020 Methods: Retrospective observational study of KT recipients included in the Spanish Covid-19 Registry (1st March to 14th November, 2020). We applied Cox multivariate analysis to identify risk factors for mortality and Kaplan-Meier and log rank survival analysis. Results: 1080 KT with Covid-19 were registered, having 937 (86.1%) their outcome reported (cure or death). Most were men (63.2%), mean age 60 years infected a median of 72 months postransplantation. Death occurred in 204 patients. Multivariate analysis found age, neumonia and KT within the last 6 months before Covid-19 were risk factors for mortality and gastrointestinal symptoms were protective. Survival analysis showed significant increasing mortality risk in four subgroups: age<65 years&postransplant time> 6mo (n=526), age<65×<6mo (n=49), age>65× >6mo (n=325) and age>65×<6mo (n=31)($$graphic). Of 1080 cases, 605 correspond to the first wave (1stW until June2020) and 475 to the second wave (2ndW). In the 2ndW, KT were younger (56.4 vs 61.1yr;p=.000), 15.8% were asymptomatic (p=.000) and presented less pneumonia (50.3% vs. 78%;p=.000). Fever, lymphopenia and respiratory symptoms were less frequent but gastrointestinal symptoms similar (30.9% vs. 34.2%;p=.256). Treatment has changed, with more use of remdesivir (p=.000) and steroids (p=.018), no use of ritonavir/lopinavir, hidroxycloroquine andazitromycin (p=.000), and no treatment in (37.1% vs 6.3% in 1stW, p=.000). Hospitalization decreased (89.2% vs. 63.2%;p=.000) but more KT were admitted to critical care units (14.5% vs 20%;p=.058). We found lower mortality (overall 26.4% vs 14.8%;p=.000, hospitalized 29% vs 23%;p=.088). Multivariate analysis of the 2ndW shows again that age, pneumonia and recent transplant (< 6 months) are mortality risk factors. Conclusions: Over a thousand KT have suffered Covid-19 in Spain with a high mortality rate in the first and second waves, mainly related with age, pneumonia and recent transplantation. The interaction between age and time after transplant has to be considered when selecting recipients in the Covid-19 pandemic.

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