Udomkarnjananun Suwasin, Kerr Stephen J, Banjongjit Athiphat, Phonphok Korntip, Larpparisuth Nuttasith, Vongwiwatana Attapong, Noppakun Kajohnsak, Lumpaopong Adisorn, Supaporn Thanom, Pongskul Cholatip, Avihingsanon Yingyos, Townamchai Natavudh
Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Excellence Center for Organ Transplantation (ECOT), King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Heliyon. 2023 Nov 24;9(12):e22811. doi: 10.1016/j.heliyon.2023.e22811. eCollection 2023 Dec.
The mortality rate of coronavirus disease 2019 (COVID-19) in kidney transplant recipients (KTR) has significantly decreased with the implementation of vaccination programs. However, the real-world information on the impact of vaccinations, particularly in resource limited settings in Asia, is still limited.
The Thai Transplant Society conducted a prospective multicenter cohort registry, including KTR diagnosed with COVID-19. Cox proportional hazards regression was used to examine factors associated with poor COVID-19 outcomes and complications, including death, COVID-19 pneumonia, and superimposed bacterial infection.
A total of 413 patients from 17 transplant centers who developed COVID-19 were analyzed. The COVID-19 mortality rate was 5.6 % and the incidence of pneumonia was 18.8 %. With each 10-year increase in age, the risk of death, pneumonia, and bacterial infection increased by 61 %, 32 %, and 43 %, respectively. A total of 11.4 % of KTR received one dose of COVID vaccination (incomplete vaccination), 25.7 % received two doses (complete primary vaccination), 42.6 % received three doses (first booster dose), and 10.4 % received four doses of vaccination (second booster dose). Even a single dose of vaccination significantly decreased the risk of death, pneumonia, and superimposed bacterial infection among KTR compared to those who remained unvaccinated. Completing the primary vaccination (2-dose) reduced the risk of death by 89 %, pneumonia by 88 %, and bacterial infection by 83 % compared to unvaccinated KTR. Receiving a booster dose (third or fourth dose) further reduced the risk of death by 94 %, pneumonia by 95 %, and bacterial infection by 96 % compared to unvaccinated individuals.
This Asian cohort demonstrated that the mortality and complications of COVID-19 significantly decreased in KTR after the national immunization. Our study suggests that any type of COVID-19 vaccine can be beneficial in preventing adverse outcomes. Administering booster vaccinations is strongly recommended.
随着疫苗接种计划的实施，肾移植受者（KTR）中2019冠状病毒病（COVID-19）的死亡率显著下降。然而，关于疫苗接种影响的真实世界信息，尤其是在亚洲资源有限的地区，仍然有限。
泰国移植学会进行了一项前瞻性多中心队列登记，纳入了被诊断为COVID-19的KTR。采用Cox比例风险回归分析与COVID-19不良结局和并发症相关的因素，包括死亡、COVID-19肺炎和叠加细菌感染。
对来自17个移植中心的413例发生COVID-19的患者进行了分析。COVID-19死亡率为5.6%，肺炎发病率为18.8%。年龄每增加10岁，死亡、肺炎和细菌感染的风险分别增加61%、32%和43%。共有11.4%的KTR接种了一剂COVID疫苗（未完成接种），25.7%接种了两剂（完成基础接种），42.6%接种了三剂（首次加强剂量），10.4%接种了四剂疫苗（第二次加强剂量）。与未接种疫苗的KTR相比，即使单剂疫苗接种也显著降低了死亡、肺炎和叠加细菌感染的风险。与未接种疫苗的KTR相比，完成基础接种（两剂）可使死亡风险降低89%，肺炎风险降低88%，细菌感染风险降低83%。与未接种疫苗的个体相比，接种加强剂量（第三剂或第四剂）可使死亡风险进一步降低94%，肺炎风险降低95%，细菌感染风险降低96%。
该亚洲队列研究表明，在全国免疫接种后，KTR中COVID-19的死亡率和并发症显著下降。我们的研究表明，任何类型的COVID-19疫苗都有助于预防不良结局。强烈建议接种加强疫苗。
