Adverse Renal Events After BNT162b2 Pfizer/BioNTech COVID-19 Vaccine in Kidney Transplant Recipients
H. K. Sran1, E. Wong1, M. R. D'Costa2, A. Lim2, Q. Lim2, A. Vathsala1
1National University of Singapore, Singapore, Singapore, 2National University Centre for Organ Transplantation, National University Hospital, Singapore, Singapore
Meeting: 2022 American Transplant Congress
Abstract number: 1644
Keywords: COVID-19, Glomerulonephritis, Proteinuria, Vaccination
Topic: Clinical Science » Infection Disease » 24 - All Infections (Excluding Kidney & Viral Hepatitis)
Session Name: All Infections (Excluding Kidney & Viral Hepatitis) IV
Session Type: Poster Abstract
Date: Tuesday, June 7, 2022
Session Time: 7:00pm-8:00pm
Presentation Time: 7:00pm-8:00pm
Location: Hynes Halls C & D
*Purpose: Adverse events of a novel mRNA vaccine are not well described in Kidney Transplant Recipients(KTR), especially the risk of immune activation or recurrent glomerulonephritis(GN), which has been described in native GN after COVID-19 vaccines.
*Methods: In this single-center prospective study, 147 KTR were enrolled after informed consent and administered 2 doses of Pfizer/BioNTech vaccine 21 days apart. Follow-up was 3 weeks after Dose2.
*Results: Mean age of KTR was 51 years; 55.1% male; 65.3% Chinese, 19% Malay, 11.6% Indian; 69.5% Living donor, 29.9% Deceased donor, 0.7% Pancreas-kidney transplants; 71.5% had biopsy-proven or presumptive chronic GN(CGN), 12.9% diabetic nephropathy, 15.6% other causes. 11(7.5%) KTR had delayed Dose2 administered at median 29 days(range 24-93) after Dose1. 7(4.8%)were delayed due to renal events: rise in creatinine(n=3), or proteinuria(n=2), or both creatinine and proteinuria with allograft biopsy showing acute T-cell and antibody-mediated rejection(n=1), new BK viraemia(n=1). Other reasons were possible anaphylaxis(n=1), intercurrent infection(n=2), and inability to attend due to quarantine(n=1). 27 KTR had new microhaematuria(MH) after Dose1; 9 persisted after Dose2. Additional 18 had new MH after Dose2. Of 45 KTR with new MH, 7 had underlying IgAN, 5 had other biopsy-proven-CGN and 22 had presumed CGN, suggesting 34/45 with possible immune activation. 12 KTR had new onset proteinuria (rise in urine protein:creatinine ratio (UPCR) ≤30 to >30mg/mmol); 5/7 who developed a rise after Dose1 remained elevated; additional 5 had a rise after Dose2. 7 KTR had rise in proteinuria from UPCR ≤100 to >100mg/mmol.
*Conclusions: Subclinical changes in allograft monitoring parameters are frequent after COVID-19 mRNA vaccines with up to 40.1% of KTRs showing rises in creatinine, proteinuria or new MH. Although overt recurrent GN and acute rejection are infrequent, high vigilance and monitoring for these occurrences should be undertaken in KTRs receiving mRNA vaccines.
|Before Dose1 (n=147)||Before Dose2 (n=146)||3 wks after Dose2 (n=142)||Overall (n=147)|
|25% rise in creatinine(%)||–||5 (3.4%)||2 (1.4%)||6 (4.1%)|
|New Microhaematuria(%)||–||27 (18.5%)||27 (19%)||45 (30.6%)|
|New UPCR >30mg/mmol(%)||–||7 (4.8%)||10 (7%)||12 (8.2%)|
|Rise in UPCR to >100mg/mmol(%)||–||4 (2.7%)||3 (2.1%)||7 (4.8%)|
|Any renal event(%)||–||39 (26.7%)||36 (25.4%)||57 (40.1%)|
To cite this abstract in AMA style:Sran HK, Wong E, D'Costa MR, Lim A, Lim Q, Vathsala A. Adverse Renal Events After BNT162b2 Pfizer/BioNTech COVID-19 Vaccine in Kidney Transplant Recipients [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/adverse-renal-events-after-bnt162b2-pfizer-biontech-covid-19-vaccine-in-kidney-transplant-recipients/. Accessed March 26, 2023.
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