LAUSR

INTRODUCTION Kidney transplantation remains the best available treatment for end-stage renal disease. However, promoting graft longevity and preventing allosensitization requires strict adherence with a stringent immunosuppression regimen. The COVID-pandemic has offered new challenges for kidney transplant patients and many transplant centers are denying transplantation to unvaccinated patients. The aim of this study was to evaluate whether unvaccinated patients had inferior adherence following kidney transplantation along with a reduction in graft survival. METHODS Patients undergoing a deceased donor kidney transplant at a single academic medical center from February 2021-May 2022 were retrospectively reviewed. February 2021 was chosen as a start date for record review as this was 3 months after the first COVID vaccination was authorized for Emergency Use. Patients were considered "vaccinated" if they received one dose or more of any mRNA vaccine by their transplant date. RESULTS There were 301 patients who met study criteria (234 vaccinated; 67 unvaccinated. Cohorts stratified by vaccination status were well-matched. However, younger age was an independent risk factor for non-vaccination. Interestingly, unvaccinated patients had worse postoperative adherence with an increased average number of postoperative clinic visits missed (p=0.03) and a strong trend towards missing .3 postoperative clinic visits (p=0.07). Lastly, unvaccinated patients had statistically more subtherapeutic tacrolimus troughs (p=0.01). CONCLUSIONS COVID-unvaccinated patients had higher rates of postoperative nonadherence in key areas of immunosuppression monitoring and clinic visit attendance. Providers should be cognizant that vaccination status may pose as a harbinger for poor adherence and stricter strategies for patient outreach are critical to ensure graft success in this vulnerable patient population.