Immunosuppression and SARS-CoV-2 Infection in Kidney Transplant Recipients

Abstract

Kidney transplant recipients (KTRs) infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may have an increased risk of mortality compared with the general population and hemodialysis patients. As these patients are immunosuppressed, it might seem obvious to attribute this excess mortality to the impaired immunity induced by immunosuppression. In line with this reasoning is the low immune response, both cellular and humoral, that KTRs mount in response to the anti-SARS-CoV-2 vaccine; however, acute respiratory distress syndrome associated with coronavirus disease 2019 is triggered by a state of inflammation and cytokine release syndrome that lead to pulmonary damage and increased mortality. In that context, immunosuppressive treatment dampening the immune response could, in theory, be potentially beneficial. This review aims at analyzing the current knowledge on the impact of immunosuppressive treatment on mortality in SARS-CoV-2-infected KTRs, the optimal management of immunosuppression in the coronavirus disease 2019 era, and the vaccine response and management in immunosuppressed KTRs.

Monoclonal Antibody Therapy in Kidney Transplant Recipients With Delta and Omicron Variants of SARS-CoV-2: A Single-Center Case Series

“… 2 , 3 These excess deaths are most likely triggered by the maintenance immunosuppressive treatments received to prevent graft rejection 4 and the co-morbidities affecting kidney transplant recipients. 5 , 6 …”

Clinical Effectiveness of SARS-CoV-2 Vaccination in Renal Transplant Recipients. Antibody Levels Impact in Pneumonia and Death

“…The general medical management of patients with SARS-CoV-2 has been adjusted to the recommendations of the moment, from March 2020 to the present. 25,29,30 In terms of immunosuppressive management, our local protocols include immunosuppressive adjustment at the time of diagnosis. Therefore, mycophenolate acid (MPA) and/or rapamycin were discontinued or reduced associated with the addition of low prednisone doses.…”

The association between pre-exposure to glucocorticoids and other immunosuppressant drugs with severe COVID-19 outcomes

“…However, the association with glucocorticoids but not with other immunosuppressants and COVID-19, may be driven by the severity of the underlying disease stage. This may differ depending on the type of disease, since multiple studies reported a higher mortality in transplant patients[ 26 ] and haematological cancer[ 27 ]. In our study, transplant patients were less likely to be hospitalized whereas were associated with an increased odds of ICU admission.…”