WHY OUR KIDNEY TRANSPLANTS RECIPIENTS (KTR) WERE NOT FULLY VACCINATED AGAINST COVID-19. HOW CAN WE DO BETTER?

WHY OUR KIDNEY TRANSPLANTS RECIPIENTS (KTR) WERE NOT FULLY VACCINATED AGAINST COVID-19. HOW CAN WE DO BETTER?

Rachel Frederick^1,2,4, Frank Ierino^2,3, Rey Lopez⁴, David Goodman^{2,3 1}Department of General Medicine, University Hospital Geelong, Geelong, Victoria, Australia²Department of Nephrology, St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia³The University of Melbourne, Parkville, Victoria, Australia⁴Department of General Medicine, St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia

Abstract

Aim: To study COVID-19 vaccination status in KTR, reasons for incomplete vaccination and the clinical impact of vaccination on COVID-19 infection and patient outcomes.
Methods: Single centre retrospective study of KTR transplanted between 1970 and January 2023. Collected baseline demographics, number of vaccinations, reason for incomplete vaccination and patient outcomes following COVID-19 infection. A completed course of COVID-19 vaccination was defined as 4 or more vaccine doses. Exclusion criteria: those deceased prior December 2019, managed by another health service, failed graft, and deceased secondary to non-COVID cause.
Results: 273 of 543 patients met inclusion criteria. Mean age was 58  12 years, 66% male. 65% of patients were fully vaccinated, 89% received at least one dose, 1% unvaccinated, and 10% incomplete records. The most common reason for incomplete vaccination was COVID-19 infection, concern for side effects, and patient unawareness of booster recommendations (figure 1). Vaccination uptake was greater in Australian born patients compared to those born overseas, odds ratio 0.40 (95% CI 0.23 – 0.69). KTR with incomplete vaccination had poorer outcomes (figure 1), higher rate of AKI, long COVID, and hospitalisation. There were 5 COVID-related deaths, but no difference in those with incomplete compared to complete vaccination.
Conclusions: The majority of KTR were fully vaccinated. KTR with incomplete vaccination status have poorer outcomes with COVID-19 infection. Patient education is a major area for improvement targeting patients born overseas and better information regarding side effects. Potential interventions need to address improved communication, cultural relevancy, and language.

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