*Purpose: SARS-CoV-2 infection in kidney transplant recipients is associated with an increased risk of severe disease and mortality relative to other patient populations, with mortality reported to be as high as 30% early in the pandemic. It has been demonstrated that vaccination against SARS-CoV-2 after transplantation is less effective as when administered prior to immunosuppression administration. To reduce the risk of poorer outcomes associated with immunosuppression, it is advisable that transplant candidates complete a SARS-CoV-2 vaccine series prior to transplantation. SARS-CoV-2 vaccine hesitancy contributes to under-vaccination in the transplant candidate population. We describe candidate perspectives associated with vaccine hesitancy in kidney transplant candidates.

*Methods: Vaccination status of actively listed kidney transplant candidates at our center was reviewed in January 2022. The infectious disease nurse practitioner performed counseling telephone visits with all available candidates not vaccinated against SARS-CoV-2 to uncover their perspectives around vaccination and determine reasons for vaccine refusal/hesitancy.

*Results: Of the 233 candidates actively listed for kidney transplant, 23 (9.8%) were found to be unvaccinated against SARS-CoV-2. Of the 23 patients, 20 (87%) were successfully contacted for telephone interview. Thirteen (65%) candidates described safety concerns as their primary reason for vaccine hesitancy. The most common concerns shared by unvaccinated candidates were a lack of trust in the development of SARS-CoV-2 vaccines, speed of development and general lack of safety data. Five (38%) of the 13 candidates expressed additional concern about the effect of vaccines could have on their native kidney function. One candidate expressed fear that vaccine will increase HLA sensitization, making it more difficult for organ matching. Three candidates stated they did not need the vaccine, citing isolation, healthy diet and prior infection as protective factors. Three candidates cited medical reasons. These included recent monoclonal antibody treatment for SARS-CoV-2 infection (2) and lymphadenopathy (1).

*Conclusions: For patients awaiting kidney transplant, the primary reason contributing to vaccine hesitancy is concern regarding vaccine safety. For some, concerns are specific to diagnosis and status as a transplant candidate. Transplant centers should continue to address vaccine hesitancy in order to provide accurate information and targeted patient education around vaccine safety and benefit to aid patients in making decisions based on available scientific data.

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