Acute Kidney Allograft Rejection Following Coronavirus mRNA Vaccination: A Case Report

Abstract

COVID-19 continues to pose a significant risk to SOT recipients, and with limited therapeutic options once infected, vaccination remains the mainstay for prevention. The mortality associated with COVID-19 infection has been widely reported to be significantly greater in patients receiving immunosuppressive agents following organ transplantation.1,2,6 Historically, recipients of SOTs have shown a diminished immunogenic response to vaccination, which imparts the risk of breakthrough infections.7 This has been demonstrated with influenza and hepatitis B vaccinations, among others.8,9 The immunogenicity toward COVID-19 vaccinations in this population has demonstrated wide variances from 0% to 59%, with one large study demonstrating that almost half of participants did not generate an immunological response.10-12 In contrast, our patient developed a strong antispike protein antibody titer, having received a full vaccine series, highlighting the unpredictability of immunological response.