COVID-19 in Solid Organ Transplant Recipients in Spain Throughout 2020: Catching the Wave?

Coll, Elisabeth; Fernández‐Ruiz, Mario; Padilla, María; Moreso, Francesc; Hernández-Vicente, Ana; Yañez, Íñigo; Molina, María; Vázquez-Sánchez, Teresa; Crespo, Marta; Facundo, Carme; Rodríguez-Ferrero, María Luisa; Fuentes, M.C. Ruiz; Loinaz, Carmelo; Bernal, Gabriel; Melilli, Edoardo; Bravo, Carlos; Diekmann, Fritz; Lladó, Laura; García-Álvarez, Teresa; Salcedo, Magdalena; Beneyto, Isabel; Castells, L.; Alonso, Raquel Cano; Rodríguez‐Benot, Alberto; Díaz‐Corte, Carmen; Graus, Javier; Ortiz‐Bautista, Carlos; García‐Cosio, María Dolores; Hinojal, Rosa; Peña, Lucía; Domínguez‐Gil, Beatriz

doi:10.1097/tp.0000000000003873

Cited by 29 publications

(45 citation statements)

References 30 publications

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“…Different studies have reported a significantly higher risk of fatal outcomes among TX patients developing COVID-19 as compared to the healthy population [23][24][25][26][27]. The main hypothesis for these poorer outcomes is based on their T-cell immunocompromised status.…”

Section: Discussionmentioning

confidence: 99%

Robust and Persistent B- and T-Cell Responses after COVID-19 in Immunocompetent and Solid Organ Transplant Recipient Patients

Zavaglio

Frangipane

Morosini

et al. 2021

Viruses

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The development and persistence of SARS-CoV-2-specific immune response in immunocompetent (IC) and immunocompromised patients is crucial for long-term protection. Immune response to SARS-CoV-2 infection was analysed in 57 IC and 15 solid organ transplanted (TX) patients. Antibody responses were determined by ELISA and neutralization assay. T-cell response was determined by stimulation with peptide pools of the Spike, Envelope, Membrane, and Nucleocapsid proteins with a 20-h Activation Induced Marker (AIM) and 7-day lymphoproliferative assays. Antibody response was detected at similar levels in IC and TX patients. Anti-Spike IgG, IgA and neutralizing antibodies persisted for at least one year, while anti-Nucleocapsid IgG declined earlier. Patients with pneumonia developed higher antibody levels than patients with mild symptoms. Similarly, both rapid and proliferative T-cell responses were detected within the first two months after infection at comparable levels in IC and TX patients, and were higher in patients with pneumonia. T-cell response persisted for at least one year in both IC and TX patients. Spike, Membrane, and Nucleocapsid proteins elicited the major CD4+ and CD8+ T-cell responses, whereas the T-cell response to Envelope protein was negligible. After SARS-CoV-2 infection, antibody and T-cell responses develop rapidly and persist over time in both immunocompetent and transplanted patients.

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Section: Discussionmentioning

confidence: 99%

Robust and Persistent B- and T-Cell Responses after COVID-19 in Immunocompetent and Solid Organ Transplant Recipient Patients

Zavaglio

Frangipane

Morosini

et al. 2021

Viruses

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“…Delayed SARS-CoV-2 PCR clearance was shown to be related to older age, multiple comorbidities, and solid organ transplant but not by overall immunosuppression burden [72]. Based on accumulating evidence, the adjustment of immunosuppression was less common during the second COVID-19 wave in Spain [131]. Various transplant society recommendations usually suggest stopping antiproliferative agents or continuing the use of standard immunosuppression [132].…”

Section: Adjustment Of Immunosuppressionmentioning

confidence: 99%

The Immunology of SARS-CoV-2 Infection and Vaccines in Solid Organ Transplant Recipients

Dęborska−Materkowska

Kamińska

2021

Viruses

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Since its outbreak in December 2019, the coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), led to an enormous rise in scientific response with an excess of COVID-19-related studies on the pathogenesis and potential therapeutic approaches. Solid organ transplant (SOT) recipients are a heterogeneous population with long-lasting immunosuppression as a joining element. Immunocompromised patients are a vulnerable population with a high risk of severe infections and an increased infection-related mortality rate. It was postulated that the hyperinflammatory state due to cytokine release syndrome during severe COVID-19 could be alleviated by immunosuppressive therapy in SOT patients. On the other hand, it was previously established that T cell-mediated immunity, which is significantly weakened in SOT recipients, is the main component of antiviral immune responses. In this paper, we present the current state of science on COVID-19 immunology in relation to solid organ transplantation with prospective therapeutic and vaccination strategies in this population.

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“…Second, the fact that we did not observe major differences in disease severity with increasing age or between patients with or without relevant comorbidities, could be due to the relatively small number of cases, narrow age range of recipients and low comorbid heterogeneity observed in our cohort. Third, although all efforts have been made to manage transplant recipients with SARS-CoV-2 infection as recommended by current guidelines, different treatments related to local standards and research protocols from other hospitals may have produced some heterogeneity across pandemic waves [ 30 ]. Fourth, the result that renal transplants are at higher risk for moderate-severe COVID-19 when compared to islet or pancreas (w/kidney) transplants is interesting, but the groups had distinct baseline characteristics.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 in Solid Organ Transplant Recipient: Exploring Cumulative Incidence, Seroprevalence and Risk Factors for Disease Severity

Caldara

Maffi

Costa

et al. 2021

Biology

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Background: Solid organ transplant (SOT) recipients may be at increased risk for severe disease and mortality from COVID-19 because of immunosuppression and prolonged end-stage organ disease. As a transplant center serving a diverse patient population, we report the cumulative incidence and outcomes of SARS-CoV-2 infection in our cohort of SOT recipients. Methods: We prospectively included in this observational study SOT recipients with a functioning kidney (n = 201), pancreas ± kidney (n = 66) or islet transplant (n = 24), attending outpatient regular follow-up at the San Raffaele Hospital from February 2020 to April 2021. Antibodies to SARS-CoV-2 were tested in all patients by a luciferase immunoprecipitation system assay. Results: Of the 291 SOT recipients, 30 (10.3%) tested positive for SARS-CoV-2 during the study period and prevalence was not different among different transplants. The SARS-CoV-2 antibody frequency was around 2.6-fold higher than the incidence of cases who tested positive for SARS-CoV-2 RT-PCR. As for the WHO COVID-19 severity classification, 19 (63.3%) SOT recipients were mild, nine (30%) were moderate, and two were critical and died yielding a crude mortality rate in our patient population of 6.7%. Kidney transplant (OR 12.9 (1.1–150) p = 0.041) was associated with an increased risk for moderate/critical disease, while statin therapy (OR 0.116 (0.015–0.926) p = 0.042) and pancreas/islet transplant (OR 0.077 (0.007–0.906) p = 0.041) were protective. Conclusions: The incidence of SARS-CoV-2 infection in SOT recipients may be higher than previously described. Due to the relative high crude mortality, symptomatic SOT recipients must be considered at high risk in case of SARS-CoV-2 infection.

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COVID-19 in Solid Organ Transplant Recipients in Spain Throughout 2020: Catching the Wave?

Abstract: Supplemental Digital Content is available in the text.

Cited by 29 publications

References 30 publications

Robust and Persistent B- and T-Cell Responses after COVID-19 in Immunocompetent and Solid Organ Transplant Recipient Patients

Robust and Persistent B- and T-Cell Responses after COVID-19 in Immunocompetent and Solid Organ Transplant Recipient Patients

The Immunology of SARS-CoV-2 Infection and Vaccines in Solid Organ Transplant Recipients

COVID-19 in Solid Organ Transplant Recipient: Exploring Cumulative Incidence, Seroprevalence and Risk Factors for Disease Severity

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