POS-817 COVID-19 INFECTION AND VACCINATION IN KIDNEY TRANSPLANT RECIPIENTS

Abstract

Mortality rate for kidney transplant recipients was reported to be 20% if they unfortunately contracted COVID-19 infection. COVID-19 vaccination has begun across the globe since the approval for emergency use on 11th December 2020. Solid organ transplant recipients are listed among COVID-19 vaccine priority groups in the 3rd Clinical Guideline on COVID-19 vaccination in Malaysia when COVID-19 vaccination programme started on 24th February 2021. This is a single center retrospective observational study. All kidney transplant recipients diagnosed with COVID-19 infection by RT -PCR from 15th December 2020 till 15th September 2021 were recruited. Demographic, clinical data and outcome were collected and analysed using SPSS version 26. We divided the patients into vaccinated and unvaccinated group and compare their clinical courses. Out of 381 kidney transplant recipients under follow up, 36 (9.4%) had COVID-19 infection. Majority were male [n=23(63.9%)]. Mean age was 44.4±15.7. Time from transplantation to COVID-19 infection was 140.9±236.9 months (0-1392 months). Twelve (33.3%) has diabetes mellitus, 23(63.9%) with hypertension, 13(36.1%) were obese and 3(8.3%) with history of malignancy. Baseline serum creatinine were 145.1±68.1µmol/L. Estimated glomerular filtration rate was 56.9±24.1ml/min/1.73m2. All patients were on steroid, 34(94.4%) on calcineurin inhibitors, 27(75%) on antimetabolites and 6(16.7%) on mammalian target of rapamycin inhibitors. Only 8 (22.2%) has completed 2 doses of COVID-19 vaccination at diagnosis of COVID-19. Sixteen(44.4%) were not vaccinated while 12(33.3%) patients received only one dose. Presentation to hospital were 2.3±2.9 days from onset of symptoms (unvaccinated 2.3±3.2 days, vaccinated 2.4±1.8 days, p=0.269). Only 6(16.7%) vaccinated patients were symptomatic compared to 16(44.0%) unvaccinated patients (p=0.441). Fever, cough, rhinorrhea and diarrhea were the commonest reported symptoms. 2/8 of the vaccinated patients (25%) required supplemental oxygen versus 7/28 (19.4%) of the unvaccinated patients (p=0.862). Four patients had severe COVID pneumonia, all unvaccinated (p=0.257). Two(5.6%) patients required mechanical ventilation, both unvaccinated(p=0.561). 3 unvaccinated (8.3%) and 1 (2.8%) vaccinated patients were admitted to intensive care unit (p=0.858). Nine patients (25%) developed acute kidney injury by KDIGO AKI criteria, 7 (19.4%) unvaccinated (p=0.719). Two (both unvaccinated) patients required kidney replacement therapy (p=0.561). Two patients (1 from each group) were complicated with pulmonary embolism. There were 4 (11.1%) mortality, all unvaccinated (p=0.257). Unvaccinated patients spent longer time 12.0±11.9 days compared to 8.8±4.0 days in vaccinated patients (p=0.079) View Large Image Figure ViewerDownload Hi-res image Download (PPT) COVID-19 cause morbidity and mortality in kidney transplant recipients. Although not statistically significant due to small sample size, vaccination improves symptoms, severity of disease, reduce complication as well as improve outcomes including death. Extension of analysis involving more vaccinated transplanted patients is needed to further study the effect of COVID-19 vaccination in this unique population.