COVID-19 vaccine immunogenicity is variable in immunocompromised patients and sub-optimal when compared to the general population. Clinical effectiveness data in solid organ transplant recipients (SOTR) remains scarce though points to a clinical benefit despite higher rate of breakthrough infection. Large multicenter studies should ideally assess incidence of breakthrough cases based on type of vaccination, time since vaccination, variants of concern, as well as the organ transplanted, age of the transplant recipient, and disease severity and outcomes. Sophisticated statistical modeling is needed to account for a variety of confounders. Lastly, duration of active viral replication in the setting of breakthrough infections remains unknown for immunosuppressed vaccinated patients and has implications for isolation duration and potential development of future viral variants. Despite advances in vaccination recommendations, now including additional vaccines doses, and medical prevention with new monoclonal antibodies, SOTR should continue to follow precautionary measures as new viral variants emerge. This article is protected by copyright. All rights reserved.
SARS‐CoV‐2 vaccine clinical efficacy in SOT: What we know and our current gaps