Immune response may detail higher COVID-19 mortality risk with dialysis, kidney transplant
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Those on dialysis or who have previously received a kidney transplant face a higher risk for COVID-19-related death after infection due to the way the virus amplifies these patients’ already intense immunophenotypic alterations.
According to a speaker at ASN Kidney Week, the immunology of COVID-19 in these patients has been “poorly explored.”
“The purpose of this study was to examine the immunophenotype and the cytokine profile of dialysis and kidney transplant patients with SARS-CoV-2 infection requiring hospital admission,” Stefania Affatato, from the University of Brescia in Lombardia, Italy, said.
Researchers observed 32 patients who were on hemodialysis (n=17) or who received a kidney transplant (n=15) and were hospitalized for COVID-19 at Spedali Civili of Brescia from March to May 2020, 12 patients on dialysis or transplant patients without COVID-19 and 10 healthy control participants.
Affatato and colleagues performed flow cytometric analyses on fresh, peripheral, whole blood samples, then assessed inflammatory soluble biomarkers using flow cytometric bead array method. Additionally, researchers measured IgG antibodies to SARS-CoV-2 Spike and nucleocapsid proteins using a “highly sensitive luciferase immunoprecipitation system assay.”
Among the 32 patients hospitalized for COVID-19, 13 showed benign disease courses while 19 died or developed COVID-19-negative acute respiratory distress syndrome (ARDS).
Patients with severe COVID-19 showed lower counts of CD4+, CD8+, CD56+, CD19+ and dendritic cells (DC) and higher counts of “terminally differentiated” CD19+ compared with controls and those without COVID-19. However, patients who died from COVID-19 or ARDS experienced lower counts of CD4+, CD8+, CD19+ and monocytes activation (MA) than those with a benign disease course.
Overall, transplant recipients showed lower CD56+, pDC and MA counts compared with patients on dialysis.
“In conclusion, patients on dialysis or with kidney transplant have profound baseline immunophenotypic alterations that are further amplified by SARS-CoV-2 infection, especially in the most severe forms,” Affatato said. “Although dialysis and kidney transplant patients are inherently heterogeneous groups, the immunological abnormalities during COVID-19 are similar across the two cohorts, with the exception of more pronounced defects in innate immunity and a dampened antibody response in kidney transplant patients.”
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Affatato S, et al. Immunological response in dialysis and kidney transplant patients with SARS-CoV-2 infection. Presented at: ASN Kidney Week; Nov. 4-7, 2021 (virtual meeting).
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