*Purpose: KTRs comprise a high-risk group for COVID-19 infection due to comorbidities and immunosuppression. Studying how vaccination hesitancy in inner-city KTRs has changed since the onset of the pandemic and their attitudes towards the vaccine in general is integral in the advancement of a successful vaccination effort.

*Methods: A random sample of 30 KTRs in 2020 and 9 recipients in 2021 were surveyed about attitudes towards and history of vaccines. Respondents who received both doses, one dose, or were planning on doing so were recorded as VACYES while those who were unsure or refused were recorded as VACNO. Respondents were also asked their top reasons for receiving or not receiving the vaccine.

*Results: Mean age in 2020 was 57.8 ± 10.6 yrs, time since transplant was 8.9 ± 6.6 yrs with18 (60%) men, 20 (71.4%) identified as black. Mean age in 2021 was 50.9 yrs ± 9.1 yrs, time since transplant 6.8 yrs ± 8.6 yrs with 3 (33.3%) men. There was no significant difference between the two samples for time since transplant, age sex, race, or percent with diabetes or hypertension. Prior to vaccine availability in 2020 only 36.7% indicated they would accept a COVID-19 vaccination. By 2021, the number had increased to 66.7% who had either received or were planning on receiving the vaccine (p < 0.001). Among the pts who were VACNO in 2020, the most commonly cited reason was concern about vaccine safety (53%). Between VACYES and VACNO patients in 2021, there were no statistically significant differences with respect to time since transplant, sex, race, education or comorbidities but VACYES pts were older (58.8±2.3 vs 47.0±8.7 yrs, p=0.021). Among VACYES, the most commonly cited reason for vaccine acceptance was that it was recommended for people with underlying conditions (80%). 100% of VACYES felt confident about the safety and efficacy of the COVID-19 vaccines compared to 33% of VACNO. 100% of VACYES believed it is okay for the government to mandate vaccinations compared to 0% of VACNO. 100% of VACNO pts felt COVID-19 was preventable vs 100% of VACYES who stated they did not know (p<0.05). 86% of both VACYES and VACNO believe that the hospital system could take care of them if sick with COVID-19.

*Conclusions: In our population: 1. Vaccine hesitancy has decreased in our inner-city KTR sample compared to the previous year, but almost 40% remain unvaccinated. 2. The most important reason cited for receiving the vaccine was because it was recommended for patients with underlying conditions. 3. Pts who received the vaccine were older, feel more confident about its safety and efficacy, and believe a government mandate is ok. 4. Pts who refused were more likely to believe that COVID-19 is preventable. 5. Regardless of vaccination status, pts believed that the healthcare system could help them if sick with COVID-19. 6. Understanding the motivation for acceptance and reasons for refusal in underserved KTR populations will be important in increasing vaccine acceptance.

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