Real-world Effectiveness of the Pfizer-BioNTech BNT162b2 and Oxford-AstraZeneca ChAdOx1-S Vaccines Against SARS-CoV-2 in Solid Organ and Islet Transplant Recipients

NHSBT Organ and Tissue Donation and Transplantation Clinical Team

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Abstract

Background. The clinical effectiveness of vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in immunosuppressed solid organ and islet transplant (SOT) recipients is unclear. 

Methods. We linked 4 national registries to retrospectively identify laboratory-confirmed SARS-CoV-2 infections and deaths within 28 d in England between September 1, 2020, and August 31, 2021, comparing unvaccinated adult SOT recipients and those who had received 2 doses of ChAdOx1-S or BNT162b2 vaccine. Infection incidence rate ratios were adjusted for recipient demographics and calendar month using a negative binomial regression model, with 95% confidence intervals. Case fatality rate ratios were adjusted using a Cox proportional hazards model to generate hazard ratio (95% confidence interval). 

Results. On August 31, 2021, it was found that 3080 (7.1%) were unvaccinated, 1141 (2.6%) had 1 vaccine dose, and 39 260 (90.3%) had 2 vaccine doses. There were 4147 SARS-CoV-2 infections and 407 deaths (unadjusted case fatality rate 9.8%). The risk-adjusted infection incidence rate ratio was 1.29 (1.03-1.61), implying that vaccination was not associated with reduction in risk of testing positive for SARS-CoV-2 RNA. Overall, the hazard ratio for death within 28 d of SARS-CoV-2 infection was 0.80 (0.63-1.00), a 20% reduction in risk of death in vaccinated patients (P = 0.05). Two doses of ChAdOx1-S were associated with a significantly reduced risk of death (hazard ratio, 0.69; 0.52-0.92), whereas vaccination with BNT162b2 was not (0.97; 0.71-1.31). 

Conclusions. Vaccination of SOT recipients confers some protection against SARS-CoV-2-related mortality, but this protection is inferior to that achieved in the general population. SOT recipients require additional protective measures, including further vaccine doses, antiviral drugs, and nonpharmaceutical interventions.32

Original languageEnglish
Pages (from-to)436-446
Number of pages11
JournalTransplantation
Volume106
Issue number3
DOIs
Publication statusPublished - 1 Mar 2022

Bibliographical note

Funding Information: The authors declare no funding or conflicts of interest.

Open Access: This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Publisher Copyright: © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.

Citation: Callaghan, Chris J. PhD1; Mumford, Lisa MSc1; Curtis, Rebecca M. K. BSc1; Williams, Sarah V. MFPH2; Whitaker, Heather PhD2; Andrews, Nick PhD2; Lopez Bernal, Jamie PhD2; Ushiro-Lumb, Ines FRCP1; Pettigrew, Gavin J. MD1; Thorburn, Douglas FRCP1; Forsythe, John L. R. FRCS1; Ravanan, Rommel FRCP1; on behalf of the NHSBT Organ and Tissue Donation and Transplantation Clinical Team* Real-world Effectiveness of the Pfizer-BioNTech BNT162b2 and Oxford-AstraZeneca ChAdOx1-S Vaccines Against SARS-CoV-2 in Solid Organ and Islet Transplant Recipients, Transplantation: March 2022 - Volume 106 - Issue 3 - p 436-446

DOI: 10.1097/TP.0000000000004059

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