Viral Clearance and Serological Response to SARS-CoV-2 in Kidney Transplant Recipients

Silvano, José; Ferreira, Filipa; Bustorff, Manuela; Nunes, Ana; Tavares, Isabel; Simões, Joana Sobrinho; Ramos, Angélica; Cardoso, Maria João; Sampaio, Susana; Pestana, Manuel

doi:10.1016/j.transproceed.2020.11.008

Cited by 11 publications

(7 citation statements)

References 23 publications

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“…In contrast, outcomes in pediatric transplant recipients appear satisfactory [ 8 , 10 ], with low rates of symptomatic infections [ 10 ], mild symptoms, few complications, and similar time to viral clearance as non-immunosuppressed children [ 7 , 8 ]. Persistent viral excretion in 11 patients in the present report was unrelated to ongoing immunosuppression but was related to COVID-19 severity, as was reported previously [ 43 ].…”

Section: Discussionsupporting

confidence: 88%

SARS-CoV-2 infection in children with chronic kidney disease

et al. 2021

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Background Information on the course of SARS-CoV-2 infection in children with chronic kidney disease (CKD) is limited. Methods We retrospectively reviewed the presentation and outcomes of SARS-CoV-2 infection in patients with CKD followed at any of the four pediatric nephrology centers in New Delhi from April 2020 to June 2021. Outcomes, including cardiopulmonary and renal complications, were reported in relation to underlying disease category and illness severity at presentation. Results Underlying illness in 88 patients included nephrotic syndrome (50%), other CKD stages 1–4 (18.2%), CKD 5D (17%), and CKD 5T (14.8%). Thirty-two of 61 patients with symptomatic COVID-19 and 9/27 asymptomatic patients were admitted for median 10 (interquartile range 7–15) days. Seventeen (19.3%) patients developed moderate or severe COVID-19. Systemic complications, observed in 30 (34.1%), included acute kidney injury (AKI, 34.2%), COVID-19 pneumonia (15.9%), unrelated pulmonary disease (2.3%), and shock (4.5%). Nineteen (21.6%) had severe complications (AKI stage 2–3, encephalopathy, respiratory failure, shock). Eight (11%) of twelve (16.4%) patients with severe AKI required dialysis. Three (3.4%) patients, two with steroid-resistant nephrotic syndrome in relapse and one with CKD 1–4, died due to respiratory failure. Univariate logistic regression indicated that patients presenting with nephrotic syndrome in relapse or moderate to severe COVID-19 were at risk of AKI (respective odds ratio, 95%CI: 3.62, 1.01–12.99; 4.58, 1.06–19.86) and/or severe complications (respective odds ratio, 95%CI: 5.92, 1.99–17.66; 61.2, 6.99–536.01). Conclusions Children with CKD presenting with moderate-to-severe COVID-19 or in nephrotic syndrome relapse are at risk of severe complications, including severe AKI and mortality. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information Supplementary Information The online version contains supplementary material available at 10.1007/s00467-021-05218-1.

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Section: Discussionsupporting

confidence: 88%

SARS-CoV-2 infection in children with chronic kidney disease

et al. 2021

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“…To our knowledge, we provide the first report on prolonged SARS-CoV-2 viral shedding in lung transplant recipients. Similar findings were described in kidney transplant recipients with 1 study reporting a kidney transplant recipient with a persistently positive nasal SARS-CoV-2 PCR at >66 d from symptom onset despite clinical recovery, 32 and another reported 25% of its kidney transplant recipient cohort with persistently positive respiratory PCR at day 30 after symptom onset. 33 Whether prolonged respiratory viral shedding also signifies a prolonged viral transmission window in lung transplant recipients with COVID-19 remains unknown.…”

Section: Discussionsupporting

confidence: 79%

One Year Into the Pandemic: Evolving COVID-19 Outcomes in Lung Transplant Recipients, a Single-center Experience

Laothamatas

Hum

Benvenuto

et al. 2022

Transplantation Direct

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Lung TransplantationBackground. In the early months of the coronavirus disease 2019 (COVID-19) pandemic, our center reported a mortality rate of 34% in a cohort of 32 lung transplant recipients with COVID-19 between March and May 2020. Since then, there has been evolving knowledge in prevention and treatments of COVID-19. To evaluate the impact of these changes, we describe the clinical presentation, management, and outcomes of a more recent cohort of lung transplant recipients during the second surge and provide a comparison with our first cohort. Methods. We conducted a retrospective cohort study that included all consecutive lung transplant recipients who tested positive for severe acute respiratory syndrome coronavirus 2 between November 2020 and February 28, 2021. We compared baseline demographics and major outcomes between the first-and second-surge cohorts. Results. We identified 47 lung transplant recipients (median age, 60; 51% female) who tested positive for severe acute respiratory syndrome coronavirus 2 between November 2020 and February 28, 2021. The current cohort had a higher proportion of patients with mild disease (34% versus 16%) and fewer patients with a history of obesity (4% versus 25%). Sixty-six percent (n = 31) required hospitalization and were treated with remdesivir (90%) and dexamethasone (84%). Among those hospitalized, 77% (n = 24) required supplemental oxygen, and 22% (n = 7) required invasive mechanical ventilation. The overall 90-d mortality decreased from 34% to 17% from the first cohort to the second (adjusted odds ratio, 0.26; 95% confidence interval, 0.08-0.85; P = 0.026). Conclusions. Although COVID-19-associated mortality rate in lung transplant recipients at our center has decreased over time, COVID-19 continues to be associated with significant morbidity and mortality.

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“…The dramatic impact of SARS-CoV-2 infection in terms of incidence and mortality among nephropathic patients was confirmed during the second pandemic wave in Italy [25]. It is well known that dialysis patients and transplant recipients are burdened by significant comorbidities and have an altered capacity of both humoral and cellular immune responses [24,[26][27][28]. The pathogenetic link between uremia and immunodepression feasibly lies in the detrimental effects of the uremic milieu itself and the related disorders on immunocompetent cells, thought different molecular and cellular pathways.…”

Section: Discussionmentioning

confidence: 99%

Persistence of Antibody Responses to the SARS-CoV-2 in Dialysis Patients and Renal Transplant Recipients Recovered from COVID-19

et al. 2021

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Nephropathic subjects with impaired immune responses show dramatically high infection rates of coronavirus disease 2019 (COVID-19). This work evaluated the ability to acquire and maintain protective antibodies over time in 26 hemodialysis patients and 21 kidney transplant recipients. The subjects were followed-up through quantitative determination of circulating SARS-CoV-2 S1/S2 IgG and neutralizing antibodies in the 6-month period after clinical and laboratory recovery. A group of 143 healthcare workers with no underlying chronic pathologies or renal diseases recovered from COVID was also evaluated. In both dialysis and transplanted patients, antibody titers reached a zenith around the 3rd month, and then a decline occurred on average between the 270th and 300th day. Immunocompromised patients who lost antibodies around the 6th month were more common than non-renal subjects, although the difference was not significant (38.5% vs 26.6%). Considering the decay of antibody levels below the positivity threshold (15 AU/mL) as “failure”, a progressive loss of immunisation was found in the overall population starting 6 months after recovery. A longer overall antibody persistence was observed in severe forms of COVID-19 (p = 0.0183), but within each group, given the small number of patients, the difference was not significant (dialysis: p = 0.0702; transplant: p = 0.1899). These data suggest that immunocompromised renal patients recovered from COVID-19 have weakened and heterogeneous humoral responses that tend to decay over time. Despite interindividual variability, an association emerged between antibody persistence and clinical severity, similar to the subjects with preserved immune function.

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Viral Clearance and Serological Response to SARS-CoV-2 in Kidney Transplant Recipients

Cited by 11 publications

References 23 publications

SARS-CoV-2 infection in children with chronic kidney disease

SARS-CoV-2 infection in children with chronic kidney disease

One Year Into the Pandemic: Evolving COVID-19 Outcomes in Lung Transplant Recipients, a Single-center Experience

Persistence of Antibody Responses to the SARS-CoV-2 in Dialysis Patients and Renal Transplant Recipients Recovered from COVID-19

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