Development of COVID-19 Infection in Transplant Recipients After SARS-CoV-2 Vaccination

Ali, Nicole M; Alnazari, Nasser; Mehta, Sapna A; Boyarsky, Brian; Avery, Robin K; Segev, Dorry L; Montgomery, Robert A; Stewart, Zoe A

BACKGROUND Immunocompromised patients were excluded from the trials of SARS-CoV-2 vaccines. Boyarsky et al recently reported that, only 17% of transplant recipients who received a single dose of SARS-CoV-2 vaccine developed detectable anti-spike antibody (compared to 100% of the nonimmunocompromised subjects in the pivotal trials) and after 2 doses response increased to 54% in transplant recipients.1,2. METHODS Retrospective chart review of 14 patients who were diagnosed with COVID-19 despite completion of vaccination series. RESULTS Fourteen SOT recipients were diagnosed with COVID-19 a median of 23.5 days from completion of vaccination. One patient died, 2 remain hospitalized and 11 are recovered at home. Fifty percent of patients infected required hospitalization for treatment of disease. CONCLUSIONS With this report of 14 patients who developed COVID-19 infection after completion of vaccination, we believe there is sufficient evidence to issue warnings that immunoincompetent populations should continue to practice strict COVID-19 precautions postvaccination. Transplant centers should reinforce that guidance given to the general population may not be applicable to the transplant population. A centralized transplant registry of fully vaccinated solid organ transplant patients who develop COVID-19 infections is vital. Further studies are critically needed to optimize COVID-19 vaccination protocols in transplant recipients.