Joint Statement with the Australian and New Zealand Society of Nephrology (ANZSN) - Vaccination against COVID-19 for Adult Patients with Kidney Failure Requiring Transplantation or Dialysis

The Australian and New Zealand Society of Nephrology (ANZSN) and the Australasian Society for Infectious Diseases (ASID) strongly recommend that adult patients with kidney failure requiring dialysis or transplantation are vaccinated against COVID-19, using any of the available vaccines that have been approved by the TGA and endorsed by ATAGI, or approved by Medsafe and in accordance with New Zealand Ministry of Health Guidelines.

Dialysis and transplant patients are at substantially higher risk of poor outcomes if they get COVID-19. Vaccination has been shown to be one of the important strategies to reduce this risk. For adult patients with kidney failure needing dialysis or transplantation, the benefits of COVID-19 vaccination in reducing the risk of severe COVID-19 disease substantially outweigh the known side effect profiles of these approved vaccines. Adult patients are recommended to receive both the initial vaccination course (2 doses), followed by a third primary dose, 2-6 months after the 2nd dose.

For adult patients with kidney disease who are waiting for, or being assessed for kidney transplantation, vaccination against COVID-19 before kidney transplantation is strongly recommended, so that protection against COVID-19 can be established before immune suppressive therapy. Delaying COVID-19 vaccination until after kidney transplantation is less effective because of the need for immune suppression with anti-rejection medications after kidney transplantation.

Clinicians and health services assessing adult patients for kidney transplantation should both advocate for, and help facilitate COVID-19 vaccination before transplantation. Assessment of a patient’s suitability for kidney transplantation requires a holistic assessment of the risks and benefits for each patient, as well as steps to optimise known risks, which will include assessing a patient’s vaccination status. We agree with the TSANZ’s statement that, “where the risk of COVID infection in the early post-transplant period is deemed to represent an unacceptably high risk, organ transplantation may not proceed.”

For potential adult kidney transplant patients who have not yet been vaccinated against COVID-19, ANZSN strongly recommends the following actions be taken to minimise the risk of serious, life-threatening COVID illness following kidney transplantation:

• Receive at least 2 doses of an approved COVID vaccine prior to kidney transplantation for maximal protection;

• Ensure household contacts and immediate family members are fully vaccinated for “ring” protection;

• Where possible, minimise contact with unvaccinated individuals; and,

• Continue to vigorously adhere to COVID-safe practices (e.g. mask wearing when

• physical distancing not possible, physical distancing, hand hygiene).