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Immunosuppression is a risk factor for severe COVID-19, and response to SARS-CoV-2 vaccination is blunted after organ transplantation. Therefore, many transplant centers required such vaccination as a condition for maintaining active status on the transplant waitlist. Whether or not this requirement disadvantages certain populations has not been examined. In a single-center study, investigators report factors associated with inactivation from the kidney transplant waitlist after institution of a COVID-19 vaccine requirement.
In all, 186 individuals removed from the waitlist for lack of COVID-19 vaccination proof were compared with 744 matched controls. Asian candidates were less likely to be inactivated than white candidates (adjusted odds ratio, 0.39), but Black candidates did not differ. Participants in the lowest (most disadvantaged) quartile of the Vaccine Equity Metric (a measure of health equity based on income, healthcare access, and education) were more likely to be inactivated than those in the highest quartile (aOR, 1.89). Education level alone was not associated with waitlist inactivation.
Edwards AL et al. Pretransplantation coronavirus disease 2019 vaccination requirements: A matched case-control study of factors associated with waitlist inactivation. Am J Transplant 2023 Sep 22; [e-pub]. (https://doi.org/10.1016/j.ajt.2023.09.009)
Comment
Although pretransplant COVID-19 vaccine mandates were sound from a purely medical perspective, this study confirms fears about their impact on healthcare equity. While keeping up to date with COVID-19 vaccine recommendations should be strongly encouraged, now that immunity from vaccination, SARS-CoV-2 infection, or both, is nearly universal in the U.S., pretransplant COVID-19 vaccine mandates are more difficult to justify. Transplant centers should address equity concerns if changing circumstances warrant the need to reconsider vaccine requirements in the future.