Liver transplantation in a patient after COVID-19 – Rapid loss of antibodies and prolonged viral RNA shedding

Nieß, Hanno; Börner, N.; Muenchhoff, Maximilian; Khatamzas, Elham; Stangl, Manfred; Graf, A.; Girl, Philipp; Georgi, Enrico; Koliogiannis, Dionysios; Denk, Gerald; Irlbeck, Michael; Werner, Jens; Guba, Markus

doi:10.1111/ajt.16349

Cited by 25 publications

(31 citation statements)

References 11 publications

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“…Prolonged SARS-CoV-2 RNA shedding has been mostly reported in immunocompromised patients (7)(8)(9)(10). These studies demonstrated that a decline or delay in antibody response could lead to relapse or recovery of COVID-19 (7). However, in a recent report involving a lymphoma patient with low immunity response, the patients were re-tested as positive for SARS-CoV-2 RNA after administration of COVID-19 convalescent plasma transfusion (11).…”

Section: Introductionmentioning

confidence: 99%

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Low Innate Immunity and Lagged Adaptive Immune Response in the Re-Tested Viral RNA Positivity of a COVID-19 Patient

et al. 2021

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Recent studies have highlighted observations regarding re-tested positivity (RP) of SARS-CoV-2 RNA in discharged COVID-19 patients, however, the immune mechanisms underlying SARS-CoV-2 RNA RP in immunocompetent patients remain elusive. Herein, we describe the case of an immunocompetent COVID-19 patient with moderate symptoms who was twice re-tested as positive for SARS-CoV-2 RNA, and the period between first and third viral RNA positivity was 95 days, longer than previously reported (18–25 days). The chest computed tomography findings, plasma anti-SARS-CoV-2 antibody, neutralizing antibodies (NAbs) titer, and whole blood transcriptic characteristics in the viral RNA RP patient and other COVID-19 patients were analyzed. During the SARS-CoV-2 RNA RP period, new lung lesions were observed. The COVID-19 patient with viral RNA RP had delayed seroconversion of anti-spike/receptor-binding domain (RBD) IgA antibody and NAbs and were accompanied with disappearance of the lung lesions. Further experimental data validated that NAbs titer was significantly associated with anti-RBD IgA and IgG, and anti-spike IgG. The RP patient had lower interferon-, T cells- and B cell-related genes expression than non-RP patients with mild-to-moderate symptoms, and displayed lower cytokines and chemokines gene expression than severe patients. Interestingly, the RP patient had low expression of antigen presentation-related genes and low B cell counts which might have contributed to the delayed anti-RBD specific antibody and low CD8+ cell response. Collectively, delayed antigen presentation-related gene expression was found related to delayed adaptive immune response and contributed to the SARS-CoV-2 RNA RP in this described immunocompetent patient.

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Section: Introductionmentioning

confidence: 99%

“…Prolonged SARS-CoV-2 RNA shedding has been mostly reported in immunocompromised patients ( 7 – 10 ). These studies demonstrated that a decline or delay in antibody response could lead to relapse or recovery of COVID-19 ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Low Innate Immunity and Lagged Adaptive Immune Response in the Re-Tested Viral RNA Positivity of a COVID-19 Patient

et al. 2021

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“…Early in the pandemic, there were only a handful of case reports describing patients who successfully underwent DDLT after recovery from SARS-CoV-2 infection. [51][52][53] In these reports, all patients had recovered with negative polymerase chain reaction (PCR) tests prior to transplantation, with the earliest transplant occurring 36 days after onset of symptoms. In one case where the patient's induction immunosuppression regimen consisted of only steroids and a calcineurin inhibitor, the patient experienced acute rejection requiring thymoglobulin and high dose steroids, without any adverse events thereafter.…”

Section: Accepted Articlementioning

confidence: 99%

Coronavirus Disease 2019 and Liver Transplantation: Lessons from the First Year of the Pandemic

Phipps

Verna

2021

Liver Transpl

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This article is protected by copyright. All rights reserved ICU (intensive care unit) LDLT (living donor liver transplantation) MELD (Model for End Stage Liver Disease) PCR (polymerase chain reaction) RRT (renal replacement therapy) SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) SRTR (Scientific Registry of Transplant Recipients) UNOS (United Network for Organ Sharing) US (United States)

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“…[8][9][10] In cases of transplantation soon after COVID-19 recovery, the viral polymerase chain reaction (PCR) was negative on more than one test for all patients prior to transplant. [11][12][13][14] Only one case exists of transplantation with a positive PCR. However, in this lung transplant recipient's preoperative swabs, the cycle threshold-the number of amplification cycles needed to detect genetic material of the virus-was persistently high, and virus was not cultured.…”

Section: Lack Of Data To Support Transplanting Actively Infected Patientsmentioning

confidence: 99%

CON: Liver Transplantation in the Times of COVID‐19: Patients with COVID‐19 Infection Should not Undergo Liver Transplantation

Whitsett

Ortiz

Weinberg

2021

Clinical Liver Disease

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Currently, there are insufficient data to conclude that liver transplantation (LT) is safe in patients with coronavirus disease 2019 (COVID-19) infection, because these patients may be at high risk for postoperative and COVID-19-related complications, graft loss, and death.• Transplantation despite high transmissibility places transplant health care workers at risk for contracting the virus and may place undue stress on the health care system by requiring higher utilization of hospital resources. • LT of COVID-19-positive patients poses an ethical dilemma, particularly regarding the principles of justice and utility.The emergence of novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has significantly impacted the world of LT. After an initial period of unprecedented challenges and uncertainty regarding the management of SARS-CoV-2-infected candidates and recipients, the transplant community temporarily halted all nonurgent LTs. Many societies developed vigorous protocols and guidelines to safely proceed with transplantation amidst the pandemic, but no guidelines recommend transplanting patients with active COVID-19 infection. Little is known regarding the safety and outcomes of LT for COVID-19-infected patients or those who contract

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Liver transplantation in a patient after COVID-19 – Rapid loss of antibodies and prolonged viral RNA shedding

Cited by 25 publications

References 11 publications

Low Innate Immunity and Lagged Adaptive Immune Response in the Re-Tested Viral RNA Positivity of a COVID-19 Patient

Low Innate Immunity and Lagged Adaptive Immune Response in the Re-Tested Viral RNA Positivity of a COVID-19 Patient

Coronavirus Disease 2019 and Liver Transplantation: Lessons from the First Year of the Pandemic

CON: Liver Transplantation in the Times of COVID‐19: Patients with COVID‐19 Infection Should not Undergo Liver Transplantation

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