Fatal breakthrough infections in solid organ transplant recipients

In a cohort study of 664 722 patients who received at least 1 dose of a SARS-CoV-2 vaccine, solid organ transplant recipients had a higher rate for COVID-19 breakthrough infection and worse outcomes after full or partial vaccination, compared with persons without immune dysfunction. We describe 4 fatal breakthroughs with liver and kidney transplant recipients aged 13-69. 

Two vaccinated solid organ transplant recipients (68M, liver and 69M, renal transplant) infected with Alpha variant had severe pneumonia requiring intensive care admission and ventilatory support and subsequently died. Both got vaccinated with BNT162b2 mRNA (Pfizer-BioNTech), were on tacrolimus medication, spent over 40 days in ICU and received Dexamethasone and Tocilizumab as part of their COVID-19 treatment. Both had Diabetes mellitus and Hypertension.

These cases were a part of case series of four fully vaccinated solid organ transplant recipients who developed SARS-CoV-2 variants of concern breakthrough infections. Three patients received BNT162b2 mRNA (Pfizer-BioNTech) and one patient received ChAdOx1 (AZD12220) COVID-19 vaccines. The patients were infected with SARS-CoV-2 variants circulating in Saudi Arabia. Two patients were infected with Alpha variant and had severe pneumonia requiring intensive care admission and ventilatory support and subsequently died. The other two patients recovered; one patient was infected with Beta variant required low supplemental oxygen via nasal flow and the other patient was infected with Delta variant and required high supplemental oxygen nasal flow. Younger patients had a better outcome than older patients. 

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REFERENCE

Almaghrabi RS, Alhamlan FS, Dada A, Al-Tawfiq JA, Al Hroub MK, Saeedi MF, Alamri M, Alhothaly B, Alqasabi A, Al-Qahtani AA, Al-Omari A. Outcome of SARS-CoV-2 variant breakthrough infection in fully immunized solid organ transplant recipients. Journal of infection and public health. 2022 Jan 1;15(1):51-5.


A 13-year-old girl with a rare genetic disorder Kabuki syndrome, end stage renal disease and a liver transplant in 2017, developed high fever after a few weeks with COVID-19, was intubated and died two weeks later.  


REFERENCE

Girl With Rare Disease Dies From COVID Complications (yahoo.com)

'Take Covid Seriously,' Family Says Of Girl Who Died Of The Virus | Wauwatosa, WI Patch

Cedarburg mother honors legacy of daughter who died from COVID (jsonline.com)


A 55-year-old male, solid-organ-transplant recipient (kidney), vaccinated with Pfizer BNT162b2 vaccine, tested positive for  20I/S:501Y.V1/VOC-alpha variant of SARS-CoV-2. He developed cough, acute hypoxic respiratory failure, sepsis and died from COVID-19.  High viral load with Ct value of 22 was detected in the nasopharyngeal specimen.

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REFERENCE

Deng X, Evdokimova M, O’Brien A, Rowe CL, Clark NM, Harrington A, Reid GE, Uprichard SL, Baker SC. Breakthrough infections with multiple lineages of SARS-CoV-2 variants reveals continued risk of severe disease in immunosuppressed patients. Viruses. 2021 Sep;13(9):1743.


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