COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Treatment Bruminhent J, Setthaudom C, Phornkittikorn P, et al. An additional dose of viral vector COVID-19 vaccine and mRNA COVID-19 vaccine in kidney transplant recipients: A randomized controlled trial (CVIM 4 study). Am J Transplant. 2022 Jul 16. doi: 10.1111/ajt.17151.
PICO Terms
adult (P) adverse reactions; safety (O) anti-RBD IgG; anti-receptor-binding domain IgG (O) booster; fourth dose (I/C) booster; third dose (I/C) Comirnaty; Pfizer vaccine; BNT162b2; BioNTech/Fosun Pharma; mRNA (I/C) heterologous, prime-boost (I/C) immunogenicity (O) kidney transplant patients (P) reactogenicity (O) seroconversion (O) spike-specific T cell response (O) Spikevax; Moderna vaccine; mRNA-1273 SARS-CoV-2; ModernaTX; mRNA (I/C) vaccine efficacy (O) Vaxzevria; AstraZeneca vaccine; ChAd0x1 nCOV-19; non-replicating viral vector; adenovirus; University of Oxford/AstraZeneca; AZD1222 (I/C)
Demographic Information
Female Male
Asian Southeast Asian

Immunogenicity following an additional dose of Coronavirus disease 2019 (COVID-19) vaccine was investigated in an extended primary series among kidney transplant (KT) recipients. Eighty-five KT participants were randomized to receive either an mRNA (M group; n = 43) or viral vector (V group; n = 42) vaccine. Among them, 62% were male, with a median (IQR) age of 50 (43-59) years and post-transplantation duration of 46 (26-82) months. At 2 weeks post-additional dose, there was no difference in the seroconversion rate between the M and V groups (70% vs. 65%, p = .63). A median (IQR) of anti-RBD antibody level was not statistically different between the M group compared with the V group (51.8 [5.1-591] vs. 28.5 [2.9-119.3] BAU/ml, p = .18). Furthermore, the percentage of participants with positive SARS-CoV-2 surrogate virus neutralization test results was not statistically different between groups (20% vs. 15%, p = .40). S1-specific T cell and RBD-specific B cell responses were also comparable between the M and V groups (230 [41-420] vs. 268 [118-510], p = .65 and 2 [0-10] vs. 2 [0-13] spot-forming units/106 peripheral blood mononuclear cells, p = .60). In conclusion, compared with an additional dose of viral vector COVID-19 vaccine, a dose of mRNA COVID-19 vaccine did not elicit significantly different responses in KT recipients, regarding either humoral or cell-mediated immunity. (TCTR20211102003).

Discipline / Specialty Area Score
Internal Medicine
Comments from MORE raters

Internal Medicine rater

Well done study comparing vaccines in this special population. Reassuring to know that the surrogate outcome of seroconversion is similar regardless of vaccine type.

Nephrology rater

Information is evolving very quickly in this area. We still don't know what seroconversion means in immunosuppressed patients. Nonetheless, this study is probably worth knowing about.