ABSTRACT
Kidney transplant recipients are at high risk of severe covid-19. Seroconversion rates comparable to those of the general population were previously described after the natural course of the disease in kidney transplant recipients. Immunosuppressive therapy, such as mycophenolic acid, limits the production of specific T-cells and antibodies following mRNA vaccination. A third booster dose significantly improves the humoral response regardless of the vaccine type chosen. Furthermore, vaccination following covid-19 infection results in high levels of specific antibodies in the majority of patients. However, the testing of humoral or cellular immune response in kidney transplant recipients is only an auxiliary tool in assessing their immunocompetence. Copyright © 2022, TIGIS Spol. s.r.o.. All rights reserved.
ABSTRACT
Purpose: Advanced age is associated with impaired humoral immune response to SARS-CoV-2 mRNA vaccines in kidney transplant recipients (KTR), however mechanisms are poorly understood. Frailty syndrome assessment in geriatric KTR may reveal the most vulnerable population. Method(s): This is the subcohort analysis of prospective study (NCT04832841) dealing with seroconversion after SARS-CoV-2 mRNA vaccination. In 101 KTR aged 70+ who were SARS-CoV-2 naive, the Fried frailty components were evaluated. Antibodies against S1 and S2 subunit of SARS-CoV-2 were evaluated >14 days after second dose of mRNA vaccines using immunochemiluminescent assay (cut off 9.5 AU/ml, sensitivity of 91.2% and specificity of 90.2%). The clinical variables affecting the humoral response were analyzed by multivariable binary regression model based on results of univariable analysis. Result(s): The seroconversion after SARS-CoV-2 vaccination was observed in 33 out of 101 (33%) KTR. In the univariable regression model, eGFR (OR=1.03, p=0.001), MMF-free immunosuppression (OR=4.32, p=0.002), physical inactivity (OR=0.36, p=0.039), grip strength (OR=1.05, p=0.045), male gender (OR=2.09, p=0.09), and Fried frailty score (OR=0.74, p=0.09) were associated with seroconversion. Multivariable binary logistic regression model adjusted for KTR age and gender retained as independent significant predictors for seroconversion the Fried frailty cumulative score (OR=0.6, p=0.048), eGFR (OR=1.05, p<0.001), MMF-free immunosuppression (OR=8.25, p=0.001) and longer follow-up from transplantation (OR=1.01, p=0.021). Conclusion(s): The frailty but not age itself is associated with impaired humoral response to SARS-CoV-2 mRNA vaccines in KTR. Intervention to reduce physical inactivity prior to vaccination may improve seroconversion rate in elderly KTR.
ABSTRACT
In the era of COVID-19 pandemic, organ transplantation programs were facing serious challenges. The lung transplantation donor pool was extremely limited and SARS-CoV-2 viral load assessment has become a crucial part of selecting an optimal organ donor. Since COVID-19 is a respiratory disease, the viral load is thought to be more important in lung transplantations as compared to other solid organ transplantations. We present two challenging cases of potential lung donors with a questionable COVID-19 status. Based on these cases, we suggest that the cycle threshold (Ct) value should always be requested from the laboratory and the decision whether to proceed with transplantation should be made upon complex evaluation of diverse criteria, including the nasopharyngeal swab and bronchoalveolar lavage PCR results, the Ct value, imaging findings and the medical history. However, as the presence of viral RNA does not ensure infectivity, it is still to be clarified which Ct values are associated with the viral viability. Anti-SARS-CoV-2 IgA antibodies may support the diagnosis and moreover, novel methods, such as quantifying SARS-CoV-2 nucleocapsid antigen in serum may provide important answers in organ transplantations and donor selections.
ABSTRACT
The article focuses on the SARS-CoV-2 infection, which represents an important and serious medicine problems worldwide. Namely, COVID-19 disease is described in the context of out-nephrology and dialysis patients and dialysis services. It contains the new data, including given recommendations in this area.