ABSTRACT
Introduction: During the first year of coronavirus disease (COVID)-19 outbreak, kidney transplant programs were suspended in several countries in the World. Republic of Belarus did not suspend organ transplant program carefully weighed the risks and benefits of pursuing or postponing kidney transplantation. In cooperation with national-level efforts, our transplant program adopted universal donor and recipient screening using reverse transcriptase polymerase chain reaction for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) with or without chest CT scans before kidney transplantation. Thus, national kidney transplant activities in Republic of Belarus remained stable for both living and deceased donor transplantation compared with the same period during the previous year. The objective was to study the safety of kidney transplantation, the incidence of COVID-19 disease in kidney transplant patients and medical care providing for transplanted patients during this pandemic period. Method(s): A retrospective review of all patients who had received a kidney transplant at State Institution "Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology" in Minsk, Republic of Belarus was performed from January 2020 to November 2022. Result(s): Dynamics of kidney transplantations number, clinical data of recipients during 3 years Covid-19 pandemic compared with the previous year are presented in table 1. The rate of infection in early postoperative period was low: 1,1% (2020), 0,5% (2021) and 0% (November 2022). In case of SARS-CoV2 infection modifications of immunosuppression (IS) therapy were based on the clinical conditions. For asymptomatic patients "wait and see approach" was mostly used;a suspension of antimetabolites drugs was adopted in the majority of patients with symptomatic COVID-19 infections. For CNIs, withdrawal was the preferred choice in severely symptomatic patients. A discontinuation of all IS drugs was used only in severely symptomatic COVID-19 patients on invasive mechanical ventilation. Since 2022 we started to use remdesivir in recipients with symptomatic course of disease with positive results. [Formula presented] From the middle of 2021 we commenced specific vaccination among transplanted patients. Most widely available vaccines in Belarus were CoronaVac (Sinovac Life Sciences, Beijing, China) and Gam-COVID-Vac (Gamaleya Research Institute of Epidemiology and Microbiology, Russia). There were no revealed any adverse effects of vaccination among our group. Conclusion(s): In our experience, the current kidney transplant program seems viable and safe, even during periods of health emergencies. No conflict of interestCopyright © 2023
ABSTRACT
Introduction. Immunocompromised individuals, such as kidney and liver recipients, are at high risk for a severe course of COVID-19, which explains the special interest in this category of patients in conditions of high incidence of this infection and mass vaccination with available vaccines. Purpose. To study the characteristics of humoral post-infection and post-vaccination immunity to SARS-CoV-2 in kidney and liver recipients based on qualitative and quantitative serotesting. Materials and methods. The study of characteristics of post-infection immunity was carried out in the group of immunocompromised individuals (n=213) including kidney (n=177) and liver (n=26) recipients with PCR confirmed COVID-19, while the study of post-vaccination immunity was carried out in the group of kidney (n=56) and liver (n=12) recipients immunized with Sputnik V (Russia) or Vero Cell (China). In comparative studies, a simple randomized sample was used of immunocompetent patients who recovered from COVID-19 (n=163), corresponding in age and gender to that of the recipients examined, as well as a convenient sample of immunocompetent individuals vaccinated with Sputnik V (n=257) and Vero Cell (n=160). Serotesting for the detection of IgG to S and N proteins of SARS-CoV-2 was carried out by ELISA. Reliable intervals for proportions were calculated using the Wald method. The significance of the detected differences was assessed by the χ2 (chi-square) method. Results. The paper presents data on comparative serological testing of kidney and liver recipients recovered from COVID-19. The detection rate of post-infectious IgG to N and S proteins of SARS-CoV-2 was found to be 88.1% in the group of kidney recipients, 91.3% in the group of liver recipients, and 91.7% in the group of immunocompetent individuals. At the same time, the proportion of N protein seropositive subjects in all groups of observation was lower in comparison with that to S protein, with a significant difference in the group of kidney recipients (59.9% and 86.4%, respectively, p<0.001). The overall dynamics of the decrease in proportion of seropositive individuals during the observation period up to 12 months from the onset of clinical manifestations of infection in both groups of recipients and in the group of immunocompetent individuals had common patterns, however, seroprevalence rates for IgG to N protein significantly differed over time (9–12 months from the onset of the disease) and were much higher in the group of immunocompetent individuals (p<0.001). Despite the presence of general patterns of post-infection antibody response formation, seroprevalence rates to SARS-CoV-2 and the duration of post-infection antibody persistence were slightly lower in the group of kidney recipients than in the group of liver recipients and in immunocompetent individuals. The immunological efficacy of vaccination (the proportion of individuals with post-vaccination antibodies) in the group of kidney recipients was significantly lower (p<0.001) than in the group of immunocompetent patients after both Sputnik V (68.0% and 98.8%, respectively) and Vero Cell (58.1% and 95.0%, respectively) immunization. In liver transplant recipients, there were no significant differences with immunocompetent individuals in terms of post-vaccination response. Conclusion. The data obtained indicate certain differences in characteristics of post-infection and post-vaccination antibody response due to patients' immune status. © 2022, Professionalnye Izdaniya. All rights reserved.