Korean J Transplant.  2022 Nov;36(Supple 1):S81. 10.4285/ATW2022.F-1989.

Severity of post-COVID-19 organizing pneumonia in kidney transplant recipients according to SARS-CoV-2 vaccination

• Choi S
• Lee H
• Kim HD
• Ko EJ
• Yang CW
• Chung BH

• KMID: 2535597
• DOI: http://doi.org/10.4285/ATW2022.F-1989

Abstract

Kidney transplant recipients (KTR) are on maintenance immunosuppression, therefore showed a higher risk for infection including coronavirus disease 2019 (COVID-19). In addition, the risk of progression to severe state of COVID-19 infection such as acute respiratory distress syndrome (ARDS) can increase in comparison within the general population. Therefore, to prevent COVID-19 infection, the importance of vaccination has been emphasized. However, the beneficial effect of vaccination in KTRs has not been fully investigated yet. In our hospital, we experienced 21 KTRs who had the COVID-19 infection and also showed postCOVID-19 organizing pneumonia (OP). We analyzed the clinical outcomes of those patients according to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination history. Fifteen patients received vaccination and the other six did not. All patients showed prolonged symptoms for more than a week after diagnosis of COVID-19 and typical chest tomographic findings including bilateral ground glass opacities or lobar consolidation. The patients were treated with the same protocol including glucocorticoid and empirical antibiotics. Post-COVID-19 OP was worse in unvaccinated KTRs. Two out of six unvaccinated patients needed renal replacement therapy (RRT) and mechanical ventilation (MV), and expired. One out of 15 vaccinated KTRs required RRT and MV, and expired. We also found the adverse outcome in older KTRs. Two out of six KTRs over the age of 65 required RRT and MV, and did not survive. One out of 15 KTRs under the age of 65 demanded RRT and MV, and expired. Among six older patients, two of the four unvaccinated patients required RRT and MV, and died of post-COVID-19 OP. Vaccinated KTRs, especially in older patients, showed better recovery after post-COVID-19 OP. Our results suggest that SARS-CoV-2 vaccination may help to prevent the development of severe form of post-COVID-19 pneumonitis, in KTRs who are infected with COVID-19.