Safety and Antibody Response to BNT162b2 and ChAdOx1 nCoV-19 Vaccines in Kidney Transplant Recipients

Background and objectives: Corona virus disease 2019 (COVID-19) is associated with significant morbidity and mortality in kidney transplant recipients (KTRs). Therefore, they are considered among the priority group for vaccination. This study presents safety data and antibody response to BNT162b2 and ChAdOx1 nCoV-19 vaccines in KTRs. Design, setting, participants, and measurements: 230 KTRs received either of the vaccines and were surveyed about adverse reactions, including timing and duration. 195 KTRs were tested for SARS-CoV-2 spike protein antibodies. Data on COVID-19 breakthrough infections were also collected. Results: Out of the 230 KTRs, 150 (65.2%) were males, mean age was 46.5 (± 14.2) years and 21 had prior COVID-19 infection. Maintenance immune-suppression included prednisone (95.7%), tacrolimus (99.6%), and mycophenolate mofetil (96.1%). 173 (75.2%) received BNT162b2 (45 one dose, 128 two doses), and 57 (24.8%) received ChAdOx1 nCoV-19 (52 one dose, 3 two doses) vaccines. Vaccines were well tolerated with pain at the site of injection, fatigue, and headache reported most in 63.9, 38.3, and 30.4%, respectively. No change in baseline creatinine or biopsy proven rejection. 23.6% developed anti-spike antibodies after one dose and 35.8% after two doses. Prior COVID-19 infection and receiving two doses of vaccine increases the likelihood of seroconversion. 20 patients had COVID-19 breakthrough infection, 17 were seronegative. Hospitalization was required in 11 patients (4 in ICU), and one patient died. Conclusion: BNT162b2 and ChAdOx1 nCoV-19 vaccines were well tolerated without major adverse events. However, the antibody response was markedly attenuated. More effective vaccination strategies using a third vaccine dose or heterologous vaccination would be warranted.