Immune monitoring facilitates the clinical decision in multifocal COVID-19 of a pancreas-kidney transplant patient

Abstract

The optimal management in transplant recipients with coronavirus disease 2019 (COVID‐19) remains uncertain. The main concern is the ability of immunosuppressed patients to generate sufficient immunity for antiviral protection. Here, we report on immune monitoring facilitating a successful outcome of severe severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2)‐associated pneumonia, meningoencephalitis, gastroenteritis, and acute kidney and pancreas graft failure in a pancreas‐kidney transplant recipient. Despite the very low numbers of circulating B, NK, and T cells identified in follow‐up, a strong SARS‐CoV‐2 reactive T cell response was observed. Importantly, we detected T cells reactive to Spike, Membrane, and Nucleocapsid proteins of SARS‐CoV‐2 with majority of T cells showing polyfunctional proinflammatory Th1 phenotype at all analyzed time points. Antibodies against Spike protein were also detected with increasing titers in follow‐up. Neutralization tests confirmed their antiviral protection. A correlation between cellular and humoral immunity was observed underscoring the specificity of demonstrated data. We conclude that analyzing the kinetics of nonspecific and SARS‐CoV‐2‐reactive cellular and humoral immunity can facilitate the clinical decision on immunosuppression adjustment and allow successful outcome as demonstrated in the current clinical case. Although the antiviral protection of the detected SARS‐CoV‐2‐reactive T cells requires further evaluation, our data prove an ability mounting a strong SARS‐CoV‐2‐reactive T cell response with functional capacity in immunosuppressed patients.

COVID-19-Induced ARDS Is Associated with Decreased Frequency of Activated Memory/Effector T Cells Expressing CD11a++

“…This hyposthesis should be tested in future studies, keeping in mind that lungs might not be the only target for the migrating T cells, as extrapulmonary manifestations of COVID-19 have been reported. [49][50][51][52][53] Our findings support the proposed hypothesis of immunopathogenesis as a leading cause of COVID-19 severe morbidity and mortality. 10,[54][55][56] In the studied patients, we observed an increased frequency of SARS-CoV-2 S-protein-reactive CD4 + and CD8 + T cells in the ARDS group.…”

Impact of COVID-19 in solid organ transplant recipients

“…In 116 samples from 35 kidney transplant recipients either IgM or IgG against SARS‐CoV‐2 recombinant nucleocapsid and spike antigens were positive in all survivors and samples more than 14 days after symptom onset, and sustained through day 59 20 . Data from the general population suggest that SARS‐CoV‐2‐specific CD4 and CD8 T cells are induced shortly after infection, contributing to viral control, 6,10 which also was observed in a case report of a renal‐pancreas recipient 113 and a small series of kidney transplant recipients 114 . However, no data are available on the stability of cellular immunity in the long term.…”

Coronavirus Disease 2019 Associated Risk Score, Behavior, and Symptom Prevalence in German Transplant Recipients

“…Overall, our findings show that asymptomatic COVID-19 courses can occur in transplant recipients. This is in line with case reports of transplant patients infected with COVID-19 that report a diverse symptomatology [ [10] , [11] , [12] , [13] ]. Common cold symptoms typical of COVID-19 were frequent, making symptom-based testing less useful.…”