Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.
Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.
Transpl Int. 2022 Jul 19;35:10626. doi: 10.3389/ti.2022.10626. eCollection 2022.
Alloimmune responses in kidney transplant (KT) patients previously hospitalized with COVID-19 are understudied. We analyzed a cohort of 112 kidney transplant recipients who were hospitalized following a positive SARS-CoV-2 test result during the first 20 months of the COVID-19 pandemic. We found a cumulative incidence of 17% for the development of new donor-specific antibodies (DSA) or increased levels of pre-existing DSA in hospitalized SARS-CoV-2-infected KT patients. This risk extended 8 months post-infection. These changes in DSA status were associated with late allograft dysfunction. Risk factors for new or increased DSA responses in this KT patient cohort included the presence of circulating DSA pre-COVID-19 diagnosis and time post-transplantation. COVID-19 vaccination prior to infection and remdesivir administration during infection were each associated with decreased likelihood of developing a new or increased DSA response. These data show that new or enhanced DSA responses frequently occur among KT patients requiring admission with COVID-19 and suggest that surveillance, vaccination, and antiviral therapies may be important tools to prevent alloimmunity in these individuals.
在 COVID-19 期间因阳性 SARS-CoV-2 检测结果而住院的肾移植 (KT) 患者的同种异体免疫反应研究不足。我们分析了在 COVID-19 大流行的头 20 个月中因 SARS-CoV-2 检测结果阳性而住院的 112 例肾移植受者的队列。我们发现，在 SARS-CoV-2 感染的 KT 患者中，新发供体特异性抗体 (DSA) 或已有 DSA 水平升高的累积发生率为 17%。这种风险会延伸到感染后 8 个月。DSA 状态的这些变化与晚期移植物功能障碍有关。在该 KT 患者队列中，新的或增加的 DSA 反应的危险因素包括 COVID-19 诊断前存在循环 DSA 和移植后时间。感染前接种 COVID-19 疫苗和感染期间使用瑞德西韦与发生新的或增加的 DSA 反应的可能性降低相关。这些数据表明，需要因 COVID-19 住院的 KT 患者中经常出现新的或增强的 DSA 反应，这表明监测、疫苗接种和抗病毒治疗可能是预防这些个体发生同种免疫的重要工具。
