Breakthrough COVID‐19 after SARS‐CoV‐2 vaccination in solid organ transplant recipients: An analysis of symptomatic cases and monoclonal antibody therapy

• Published in: Transplant infectious disease 2022-04, Vol.24 (2), p.e13779-n/a
• Main Authors: Yetmar, Zachary A., Bhaimia, Eric, Bierle, Dennis M., Ganesh, Ravindra, Razonable, Raymund R.
• Format: Article
• Language: English
• Subjects: Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; breakthrough infection; casirivimab–imdevimab; COVID-19; COVID-19 Vaccines; Emergency medical care; Emergency medical services; Humans; Immunization; Immunotherapy; Kidney transplantation; Middle Aged; Monoclonal antibodies; monoclonal antibody therapy; organ transplantation; Organ Transplantation - adverse effects; Patients; SARS-CoV-2; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Therapy; Transplant Recipients; Vaccination
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/tid.13779

Background Solid organ transplant (SOT) recipients are at increased risk for complications from SARS‐CoV‐2 infection. Little is known regarding clinical course and outcomes of breakthrough COVID‐19 in the fully vaccinated SOT population. We sought to describe our cohort of SOT recipients who developed symptomatic breakthrough COVID‐19 after full vaccination. Methods We conducted a retrospective review of SOT recipients diagnosed with COVID‐19 at least 14 days after completing SARS‐CoV‐2 vaccination. Patients were analyzed according to those presenting with mild‐to‐moderate and severe COVID‐19, respectively. We described presenting characteristics, COVID‐19 therapy, and analyzed outcomes including emergency department (ED) visits, hospitalization, and intensive care unit (ICU) admission. Results Thirty‐five patients met inclusion criteria. These had a mean age of 60.8 years and kidney transplant was the most common SOT type. Five patients presented with severe COVID‐19 at diagnosis, all requiring hospitalization without ICU admission. From the 30 patients who presented with mild‐to‐moderate infection, 28 received casirivimab–imdevimab. Four of these 28 (14.3%) had an ED visit, with one requiring hospital admission (3.4%). No patients required ICU admission. Conclusion Breakthrough COVID‐19 may occur in SOT recipients after full vaccination, though they appear to have acceptable outcomes. Anti‐spike monoclonal antibody therapy for eligible SOT patients may have mitigated clinical progression and improved the outcomes. Further study with large cohorts is warranted.