Nephrology Department, Saint Joseph University, Hôtel-Dieu de France, Beirut, Lebanon.
Pathology Department, Saint Joseph University, Hôtel-Dieu de France, Beirut, Lebanon.
BMC Nephrol. 2022 Mar 5;23(1):91. doi: 10.1186/s12882-022-02713-x.
Antibody-mediated rejection (AMR) was described in kidney transplant patients after viral infections, such as the cytomegalovirus. Very few cases were recently reported after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, probably in the context of lowering of immunosuppressive therapy. To date, no direct immunological link was proved to explain a connection between the coronavirus disease 19 (COVID-19) infection and antibody-mediated rejection (AMR) if it exists.
Here we try to find this association by presenting the case of a low immunological risk patient who presented, six years post-transplant, with c4d negative antibody mediated rejection due to an anti-HLA-C17 de novo donor specific antibody (DSA) after contracting the coronavirus disease 19. The HLA-Cw17 activated the antibody-dependent cell-mediated cytotoxicity via the KIR2DS1 positive NK cells.
This case report may prove a direct role for COVID-19 infection in AMRs in the kidney transplant recipients, leading us to closely monitor kidney transplant recipients, especially if they have "at-risk" donor antigens.
在肾移植患者中，病毒感染（如巨细胞病毒）后会发生抗体介导的排斥反应（AMR）。最近报道了少数几例严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染后的病例，可能与免疫抑制治疗降低有关。迄今为止，如果冠状病毒病 19（COVID-19）感染与抗体介导的排斥反应（AMR）之间存在联系，尚无直接免疫学联系来解释这一点。
在这里，我们通过介绍一名低免疫风险患者的病例来尝试寻找这种关联，该患者在移植后六年出现 c4d 阴性抗体介导的排斥反应，原因是感染 COVID-19 后产生了针对 HLA-C17 的新供体特异性抗体（DSA）。HLA-Cw17 通过 KIR2DS1 阳性 NK 细胞激活抗体依赖性细胞介导的细胞毒性。
本病例报告可能证明 COVID-19 感染在肾移植受者的 AMR 中具有直接作用，这促使我们密切监测肾移植受者，特别是如果他们具有“风险”供体抗原的话。
