COVID-19 Publications

The Transplant Library provides a comprehensive overview of free COVID-19 information relevant for transplantation professionals.
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  • Joerns J
  • Bollineni S
  • Mahan LD
  • Mohanka MR
  • Lawrence A
  • et al.
Transplantation. 2022 May 1;106(5):e271-e274 doi: 10.1097/TP.0000000000004089.
  • Mitchell J
  • Chiang TP
  • Alejo JL
  • Chang A
  • Abedon AT
  • et al.
Transplantation. 2022 May 1;106(5):e269-e270 doi: 10.1097/TP.0000000000004090.
  • Medina-Pestana J
  • Cristelli MP
  • Foresto RD
  • Tedesco-Silva H
  • Requião-Moura LR
Transplantation. 2022 May 1;106(5):908-910 doi: 10.1097/TP.0000000000004086.
  • Benotmane I
  • Bruel T
  • Planas D
  • Fafi-Kremer S
  • Schwartz O
  • et al.
Kidney Int. 2022 May;101(5):1073-1076 doi: 10.1016/j.kint.2022.02.011.
  • McEvoy CM
  • Lee A
  • Misra PS
  • Lebovic G
  • Wald R
  • et al.
Transplantation. 2022 May 1;106(5):e279-e280 doi: 10.1097/TP.0000000000004081.
  • Tang K
  • Wu X
  • Luo Y
  • Wei Z
  • Feng L
  • et al.
J Infect. 2022 May;84(5):e73-e75 doi: 10.1016/j.jinf.2022.02.016.
  • Saiag E
  • Grupper A
  • Avivi I
  • Elkayam O
  • Ram R
  • et al.
Clin Microbiol Infect. 2022 May;28(5):735.e5-735.e8 doi: 10.1016/j.cmi.2022.02.002.
OBJECTIVES:

The recent surge in coronavirus disease 2019 cases led to the consideration of a booster vaccine in previously vaccinated immunosuppressed individuals. However, the immunogenic effect of a third-dose severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine in immunosuppressed patients is still unknown.

METHODS:

This was an observational cohort study of 279 previously vaccinated immunosuppressed patients followed at a single tertiary hospital in Israel. Patients were administered a third dose of the Pfizer-BioNTech mRNA vaccine (BNT162b2) between July 14 and July 21, 2021. Levels of IgG antibodies against the spike receptor-binding domain of SARS-CoV-2 were measured 3 to 4 weeks after vaccination.

RESULTS:

Of the cohort of 279 patients, 124 (44.4%) had haematologic malignancies, 57 (20.4%) had rheumatologic diseases, and 98 (35.1%) were solid organ-transplant recipients. Anti-SARS-CoV-2 antibody levels increased in 74.9% of cases. Across the entire cohort, the median absolute antibody levels (expressed in AU/mL) increased from 7 (interquartile range (IQR), 0.1-69) to 243 (IQR, 2-4749) after the booster dose. The response significantly varied across subgroups: The transplant cohort showed the greatest increase in absolute antibody levels (from 52 (IQR, 7.25-184.5) to 1824 (IQR, 161-9686)), followed by the rheumatology (from 22 (IQR, 1-106) to 1291 (IQR, 6-6231)) and haemato-oncology (from 1 (IQR, 0.1-7) to 7.5 (IQR, 0.1-407.5)) cohorts. The χ2 test was 8.30 for difference in fold change (p = 0.016). Of the 193 patients who were seronegative at baseline, 76 became seropositive after vaccination, corresponding to a 39.4% (95% CI, 32.8%-46.4%) seroconversion rate. Transplant patients had the highest seroconversion rate (58.3% (95% CI, 44.3%-71.2%)), followed by rheumatology (44.1% (95% CI, 28.9%-60.5%)) and haemato-oncology (29.7% (95% CI, 22%-38.8%); χ2 = 11.87; p = 0.003) patients.

DISCUSSION:

A third dose of BNT162b2 is immunogenic in most immunosuppressed individuals, although antibody response may differ based on the type of disease and immunosuppression. The antibody level that correlates with protection is still unknown; thus, future studies are needed to evaluate clinical outcomes.

  • Abedon AT
  • Teles MS
  • Alejo JL
  • Kim JD
  • Mitchell J
  • et al.
Transplantation. 2022 May 1;106(5):e262-e263 doi: 10.1097/TP.0000000000004092.
  • Masset C
  • Gautier-Vargas G
  • Cantarovich D
  • Ville S
  • Dantal J
  • et al.
Kidney Int Rep. 2022 May;7(5):983-992 doi: 10.1016/j.ekir.2022.01.1072.
INTRODUCTION:

Decreased immunosuppression has been proposed for kidney transplant recipients infected with coronavirus disease 2019 (COVID-19), but the impact on the alloreactive immune response during and after infection has been poorly investigated. We evaluated the occurrence of antihuman leukocyte antigen (HLA) donor-specific antibodies (DSAs) (post-COVID-19) and rejection episodes after COVID-19 with particular focus on immunosuppression modulation.

METHODS:

Kidney transplant recipients from 2 French institutions had anti-HLA antibody screening before and after COVID-19. Management of immunosuppression, rejection episodes, COVID-19 severity, inflammatory markers, and antiviral therapies were recorded.

RESULTS:

From 251 recruited patients, 72 were excluded because of COVID-19-related death (n = 25) and incomplete immunologic follow-up (n = 47). Among the remaining 179 included patients, almost half were hospitalized (49.2%). Antimetabolites were interrupted in 47% of patients (82% in hospitalized, median time of resumption of 23 days and in 15% nonhospitalized, median time of resumption of 7 days). Calcineurin inhibitors were interrupted in 12% of patients (all hospitalized, median time of resumption of 11 days). The incidence of post-COVID-19 DSA was 4% (8% and 0% in hospitalized and nonhospitalized, respectively). Allograft rejection occurred in 3 patients (1.7%) and all were hospitalized. Younger age, transplantation <1 year, and preexisting DSA were more frequently observed in patients with post-COVID-19 DSA, whereas inflammatory markers, lymphopenia, and use of antiviral therapies were not.

CONCLUSION:

The incidence of post-COVID-19 DSA among COVID-19-positive kidney transplant recipients was low (4%) despite a significant decrease in immunosuppression and was mainly restricted to high-risk immunologic patient's status. COVID-19 severity was not associated with post-COVID-19 DSA and/or rejection.

  • Favà A
  • Donadeu L
  • Jouve T
  • Gonzalez-Costello J
  • Lladó L
  • et al.
Kidney Int. 2022 May;101(5):1027-1038 doi: 10.1016/j.kint.2021.12.029.

Long-term adaptive immune memory has been reported among immunocompetent individuals up to eight months following SARS-CoV-2 infection. However, limited data is available in convalescent patients with a solid organ transplant. To investigate this, we performed a thorough evaluation of adaptive immune memory at different compartments (serological, memory B cells and cytokine [IFN-γ, IL-2, IFN-γ/IL12 and IL-21] producing T cells) specific to SARS-CoV-2 by ELISA and FluoroSpot-based assays in 102 convalescent patients (53 with a solid organ transplants (38 kidney, 5 liver, 5 lung and 5 heart transplant) and 49 immunocompetent controls) with different clinical COVID-19 severity (severe, mild and asymptomatic) beyond six months after infection. While similar detectable memory responses at different immune compartments were detected between those with a solid organ transplant and immunocompetent individuals, these responses were predominantly driven by distinct COVID-19 clinical severities (97.6%, 80.5% and 42.1%, all significantly different, were seropositive; 84% vs 75% vs 35.7%, all significantly different, showed IgG-producing memory B cells and 82.5%, 86.9% and 31.6%, displayed IFN-γ producing T cells; in severe, mild and asymptomatic convalescent patients, respectively). Notably, patients with a solid organ transplant with longer time after transplantation did more likely show detectable long-lasting immune memory, regardless of COVID-19 severity. Thus, our study shows that patients with a solid organ transplant are capable of maintaining long-lasting peripheral immune memory after COVID-19 infection; mainly determined by the degree of infection severity.