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BACKGROUND AND AIMS The clinical effectiveness of COVID-19 vaccination in kidney transplant (KT) recipients is lower than in the general population. However, the evidence reported is limited so far. Our purpose is to analyze the characteristics and outcomes of a large series of KT with COVID-19 breakthrough infection and compare them with unvaccinated patients. As a secondary objective, we analyzed the evolution according to the type of mRNA vaccine administered. METHOD From April to October 2021, KT recipients with COVID-19, included in the Spanish Society of Nephrology COVID-19 Registry, were analyzed. Data regarding vaccination status and type of vaccine were collected and outcomes of unvaccinated patients were compared with fully vaccinated patients. Univariable and multivariable Cox proportional hazard regression analyses were assessed for independent risk factors of COVID-19-related death. To avoid bias as much as possible, a sensitivity analysis was done exclusively in hospitalized patients. RESULTS During the period of the study, 481 KT recipients with COVID-19 were included in the registry: 351 fully vaccinated and 130 unvaccinated. Age, gender, KT vintage, diabetes as primary kidney disease, induction and maintenance immunosuppression and anti-COVID therapy were similar between both groups. Clinical picture was similar between fully vaccinated and unvaccinated patients: 10% versus 15.4% remained asymptomatic (P = 0.100), 56.7% versus 58.5% developed pneumonia (P = 0.720) and 66.1% versus 63.8% were hospitalized (P = 0.640), respectively. Survival analysis showed no differences between groups: 21.7% of fully vaccinated patients and 20.8% of unvaccinated died (P = 0.776). In multivariable analysis, age (HR: 1.05, CI 95% 1.03–1.08, P Regarding the type of mRNA vaccine, 213 patients were vaccinated with the mRNA-1273 vaccine (Moderna) and 161 with the BNT162b2 (Pfizer-BioNTech), showing no differences in any of baseline and treatment-related variables analyzed. Patients vaccinated with the mRNA-1273 vaccine showed a significantly lower mortality than those who received BNT162b2 (16.4% versus 28.8%, P = 0.002), maintaining this difference in the multivariable analysis (reference mRNA-1273 vaccine: HR: 0.52, CI: 95% 0.31–0.85, P = 0.010). CONCLUSION COVID-19 severity in KT patients has remained high and has not improved despite receiving two doses of an mRNA vaccine. The mRNA-1273 vaccine has shown higher clinical effectiveness than BNT162b2 in KT recipients with breakthrough infection, so it could be considered as the first option in these patients.

Background and Aims Long-term immunosuppression in solid organ transplant (SOT) recipients could be associated with high risk of cutaneous malignancies. Any suspicious lesion should be excised and sent for pathologic examination. Method We performed a descriptive retrospective single-center study to evaluate the incidence of all skin cancer lesions in 372 kidney transplanted recipients between January 2015 to July 2020 with at least 6 months of follow-up. Results We identified 53 recipients who developed skin diseases during post transplant period. Mean age was 63y, predominantly men (62%), caucasian race, with light phototype (I-II 95%).Mean follow-up were 16 months (45% first year, 23% second year, and 32%> 3 years). 70% of the patients were over 60y with an earlier development of the lesions. Actinic keratosis was the most frequent non- excised lesion. 27 patients were biopsied (51%) in whom 66% showed malignant skin lesions (squamous cell carcinoma-SCC: 39%; Basal cell carcinoma-BCC: 50%; melanoma 11%). The most frequent immunosuppressive treatment (IS) associated between these recipients was the combination of tacrolimus (Tac) and mycophenolate (MMF; 62%) versus tacrolimus (Tac) and everolimus scheme (EVE; 38%). Up to 18.5% had multiple and mixed carcinomas. 4 to 5 patients of them were with MMF regimen. This treatment was also more frequent among patients with SCC (33%). Conclusion

Introduction:Remdesivir has demonstrated antiviral activity against coronavirus, shortening the time torecovery in adults hospitalized with moderate/severe COVID-19. Severe adverse events such as acutekidney injury have been reported. Scant data are available on the use and safety of remdesivir in kidneytransplant recipients.Methods:We present a multicenter cohort study of 51 kidney transplant recipients with COVID-19 treatedwith remdesivir. Outcomes and safety were assessed.Results:Mean age at diagnosis was 60 years, with a median time since kidney transplant of 4.5years. Mean time since admission to remdesivir was 2 days. Twenty-eight patients (54.9%) requiredmechanical ventilation (19 noninvasive). Mortality was 18.9% and markedly higher if aged$65 years(45% vs. 3.2% in younger patients). Acute kidneyinjury was present in 27.7% of patients, but wasdiagnosed in 50% before treatment. No patients required remdesivir discontinuation because ofadverse events. We did notfind significant hepatoxicity or systemicsymptoms resulting from thedrug. Conclusion:In our cohort of kidney transplant recipients, remdesivir was well tolerated and safe in renaland hepatic toxicity, but randomized trials are needed to assess its efficacy. The authors are indebted to the many physicians andnurses who take care of these patients and are facing theCOVID-19 pandemic in our country. This research wassupported by Rio Hortega contract CM19/00004 (ISCIII)(AB), and RD16/0009/0013 (ISCIII FEDER RedinRen). MJP-S is supported by a Spanish Society of Transplantscholarship

Background and Aims HEMO study showed that β2M level over time was predictive of all-cause mortality in haemodialysis patients (HD). Later studies suggested that protein-bound uremic toxins are associated with mortality in HD patients but with recent contrasting results. Aim of study was to analyse β2M and indoxyl sulfate (IS) as predictor factors of mortality. Method 5 years follow-up of 60 prevalent HD patients of our hospital. Demographic data was described. Baseline midweek pre-dialysis serum β2M was determined by nephelometry and total IS levels by high performance liquid chromatograph connected to a UV detector. We considered high serum β2M group as if was equal or higher than 27,5 mg/L. As to IS, patients were divided into quartiles (1q 26.5 mg/L). Survival curves were assessed using the Kaplan–Meier analysis at 1,2,3 and 5 years in univariate analysis for albumin (≥38 g/L or lower), β2M, and total IS groups, and evaluated by the proportional hazards Cox´s model. P -values Results 60 prevalent patients with mean vintage of 46,8 months (range 3-299 months). Mean age was 60±20 years. Males were more prevalent (53,3% vs 46,6%). 35% had diabetes. 51,6% underwent conventional hemodialysis (HD), 48,3% post-dilution haemodiafiltration, with mean convective volume of 23,8±2,8L. Mean eKt/V was 1,67±0,4, mean nPCR was 1±0,27g/kg/day. Only 8,3% of patients had urine volume>500cc/24hours. Mean β2M level was 35,6±1,9mg/L (X±SE) and mean total IS level was 18,9±1,6mg/L. The overall mortality at 5 years was 57%. Albuminemia lower than 38g/L was associated with mortality at 2, 3, and 5-years in univariate analysis (Cox´s F test p=0.03, figure 1). We found no difference in survival rate between patients with high or low serum β2M levels at 3- or 5-years analysis (Cox´s F test p=0.27). At 2 years analysis, patients in the lower β2M group had better survival (Cox´s F test p=0.04, Figure 1). There was no statistically significant association between albumin, β2M, IS level and all-cause mortality on Cox regression multivariate analysis. We observe no statistically significant association between IS levels and all-cause mortality neither on univariate, nor on multivariate analysis. Conclusion β2M < 27,5 mg/l was associated with better survival at 2 years univariate analysis. IS had no statistically significant association with all-cause mortality in our cohort.