Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.
Laboratory of Hepatology, Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium.
Transplantation. 2022 Apr 1;106(4):862-868. doi: 10.1097/TP.0000000000003955.
There is a paucity of data on the prevalence, adequate timing, and outcome of solid organ transplantation after severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and the kinetics of immunoglobulin G (IgG) antibodies in these patients.
SARS-CoV-2 antinucleocapsid (N) IgG and polymerase chain reaction via a nasopharyngeal swab were analyzed in all patients within 24 h before liver or kidney transplantation. Kinetics of IgG antibodies were analyzed and compared with an immunocompetent cohort.
Between May 1, 2020, and March 18, 2021, 168 patients underwent liver or kidney transplantation in our center, of which 11 (6.54%) patients with a previous SARS-CoV-2 infection were identified. The median interval between SARS-CoV-2 infection and transplantation was 4.5 mo (range, 0.9-11). After a median posttransplant follow-up of 4.9 mo, 10 out of 11 patients were alive without clinical signs of viral shedding or recurrent or active infection. One patient without symptom resolution at time of transplantation died after combined liver-kidney transplantation. In 9 out of 11 patients with previously polymerase chain reaction-confirmed infection, SARS-CoV-2 anti-N and antispike (S) IgG were detectable at day of transplantation. Absolute levels of anti-N and anti-S IgG were positively correlated, declined over time in all patients, and were significantly lower compared with immunocompetent individuals. All patients remained anti-S IgG positive until the last posttransplant follow-up, whereas 3 patients became anti-N negative.
We observed an uncomplicated course of liver or kidney transplantation after SARS-CoV-2 infection in selected patients. Although having lower absolute IgG antibody levels than immunocompetent individuals, all seroconverted patients remained anti-S IgG positive. These encouraging data need validation in larger studies.
关于严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染后实体器官移植的患病率、适当时间和结果，以及这些患者免疫球蛋白 G（IgG）抗体的动力学，数据十分有限。
在肝或肾移植前 24 小时内，通过鼻咽拭子分析所有患者的 SARS-CoV-2 抗核衣壳（N）IgG 和聚合酶链反应。分析 IgG 抗体的动力学并与免疫功能正常的队列进行比较。
2020 年 5 月 1 日至 2021 年 3 月 18 日期间，我们中心有 168 例患者接受了肝或肾移植，其中 11 例（6.54%）患者既往有 SARS-CoV-2 感染史。SARS-CoV-2 感染与移植之间的中位间隔为 4.5 个月（范围：0.9-11）。中位移植后随访 4.9 个月后，11 例患者中的 10 例存活，无病毒脱落或复发性或活动性感染的临床迹象。1 例移植时症状未缓解的患者在接受肝-肾联合移植后死亡。在 9 例先前聚合酶链反应确诊感染的患者中，9 例在移植当天可检测到 SARS-CoV-2 抗 N 和抗刺突（S）IgG。所有患者的抗-N 和抗-S IgG 绝对水平呈正相关，随时间推移均逐渐下降，且显著低于免疫功能正常的个体。所有患者在最后一次移植后随访时仍保持抗-S IgG 阳性，而 3 例患者抗-N 转为阴性。
我们观察到在选定的患者中，SARS-CoV-2 感染后肝或肾移植的过程较为顺利。尽管与免疫功能正常的个体相比，绝对 IgG 抗体水平较低，但所有血清转化患者仍保持抗-S IgG 阳性。这些令人鼓舞的数据需要在更大的研究中进一步验证。
