Thread by @costisifri

1/ Transplant patients have significantly reduced antibody responses to #COVID vaccination. But does that matter? This report shows that it does. SOT recipients have a 82-fold higher risk of #breakthrough infection compared to immunocompetent hosts.

journals.lww.com/transplantjour…

2/ Even more important, serious consequences of #breakthrough infection are even more common in SOT receipts. They have a 485-fold higher risk of breakthrough infections that lead to hospitalization or death.

3/ Reporting the results as cases per million vaccinated puts this into perspective. For example, the CDC reported that a little more than 1 in 1 million normal hosts (immunocompetent ppl) will die from COVID following vaccination. For transom at recipients, that number is 664.

4/ The trial reflected the real world experience of over 18 thousand transplant recipients at 16 U.S. transplant centers.

5/ Since this report reflects real world experience, the results may not be completely accurate. However, it may, if anything, underestimate the risk of breakthrough infection in transplant recipients.

6/ Multiple questions are raised by this study. What’s the impact of the transplant (i.e. organ, time after transplant, I/S)? What’s the impact of the virus (i.e. G614D, alpha, #DeltaVariant)? What’s the impact of the vaccine (i.e. mRNA, J&J)?

7/ Most importantly, what’s the optimal strategy to improve efficacy of COVID vaccination for transplant recipients?
3️⃣x💉?

8/ One thing is clear however. The best defense against #COVID for transplant recipients and other Immunocompromised ppl is for EVERYONE who is eligible to get vaccinated.

Kudos to @Dorry_Segev @kierenamarr and colleagues on this important study. Happy to assist. Hopefully we will learn answers to some of the questions posed, and the CDC/ACIP will be be able to provide guidance on how to help these vulnerable ppl soon. #IDTwitter #Txp

To be clear, this doesn’t prove that measured Ab responses are necessarily protective or provide insights into the relative importance of celllular immunity. It just confirms what we see in our ICUs. Serious breakthrough COVID infections almost always occur in compromised hosts.