Clinical characteristics of COVID‐19 in solid organ transplant recipients following COVID‐19 vaccination: A multicenter case series

Background Solid organ transplant recipients (SOTR) have diminished humoral immune responses to COVID‐19 vaccination and higher rates of COVID‐19 vaccine breakthrough infection than the general population. Little is known about COVID‐19 disease severity in SOTR with COVID‐19 vaccine breakthrough infections. Methods Between 4/7/21 and 6/21/21, we requested case reports via the Emerging Infections Network (EIN) listserv of SARS‐CoV‐2 infection following COVID‐19 vaccination in SOTR. Online data collection included patient demographics, dates of COVID‐19 vaccine administration, and clinical data related to COVID‐19. We performed a descriptive analysis of patient factors and evaluated variables contributing to critical disease or need for hospitalization. Results Sixty‐six cases of SARS‐CoV‐2 infection after vaccination in SOTR were collected. COVID‐19 occurred after the second vaccine dose in 52 (78.8%) cases, of which 43 (82.7%) occurred ≥14 days post‐vaccination. There were six deaths, three occurring in fully vaccinated individuals (7.0%, n = 3/43). There was no difference in the percentage of patients who recovered from COVID‐19 (70.7% vs. 72.2%, p = .90) among fully and partially vaccinated individuals. We did not identify any differences in hospitalization (60.5% vs. 55.6%, p = .72) or critical disease (20.9% vs. 33.3%, p = .30) among those who were fully versus partially vaccinated. Conclusions SOTR vaccinated against COVID‐19 can still develop severe, and even critical, COVID‐19 disease. Two doses of mRNA COVID‐19 vaccine may be insufficient to protect against severe disease and mortality in SOTR. Future studies to define correlates of protection in SOTR are needed