Low incidence of donor-specific antibodies for kidney transplant recipients with COVID-19
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Despite a significant decrease in immunosuppression, the occurrence of post-COVID-19 donor-specific antibodies among COVID-19-positive kidney transplant recipients was low, according to data published in Kidney International Reports.
“Greater severity of COVID-19 has been reported in kidney transplant recipients and is most likely due to comorbidities and immunosuppressive therapy,” Christophe Masset, MD, from the Clinic Institute of Transplantation Urology Nephrology (ITUN) at the University Hospital of Nantes in France, and colleagues wrote. “Our study aimed to search the occurrence of donor-specific antibodies (DSA), documented acute rejection episodes and graft losses during and after COVID-19 in kidney transplant recipients, according to the clinical disease severity and the way immunosuppression was managed.”
In a retrospective cohort analysis, researchers measured the occurrence of DSAs and allograft rejection in 251 kidney transplant recipients following COVID-19 infection. All patients underwent anti-human leukocyte antigen antibody screening before and after COVID-19 infection. Researchers recorded and analyzed management of immunosuppression, rejection episodes, COVID-19 severity, inflammatory markers and antiviral therapies.
Among the 251 patients recruited, 25 patients died and 47 failed to complete immunological follow-ups. Of the remaining 179 patients, 49.2% were hospitalized.
Analyses revealed anti-metabolites were interrupted in 47% of patients, and calcineurin inhibitors were interrupted in 12% of patients. The overall incidence of post-COVID-19 DSA and acute rejection was 4% and 1.7%, respectively. Researchers noted younger age, transplantation less than 1 year and preexisting DSA were linked to post-COVID-19 DSA-positive patients, while inflammatory markers, lymphopenia and use of antiviral therapies were not.
According to researchers, limitations of the study include the absence of a control group.
“The occurrence of post-COVID DSA seemed more likely to be related to an immunological higher patient’s risk status rather than immunosuppression modulation, alloimmune response induced by the virus and any adjunctive antiviral therapy used,” Masset and researchers wrote. “Transient interruption of immunosuppression for kidney transplant patients infected by COVID-19 appears to be safe, at least within the evaluated time of this study.”
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