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Background: COVID-19 in solid organ transplant recipients is usually characterized by a more severe disease course and is often associated with life-threatening complications. Identification of additional factors that may affect the risk and severity of the new coronavirus infection could have a significant impact on choosing a management strategy for renal graft recipients. Aim: to evaluate the possibility of cross-immunity between skin manifestations of viral etiology and COVID-19. Materials and methods: from May 2020 to February 2021 we examined 180 renal graft recipients with a history of transplantation from 2 months to 26.5 years. All patients were categorized into two groups: group I, those who had confirmed moderate or severe COVID-19 disease, and group II, and those without any history of clinical manifestations of the new coronavirus infection (including those with potentially asymptomatic disease). During the study period which lasted for 71 months on average (range, 2 to 318 months), laboratory workup was performed on all patients (on average, twice): dermatological examination and detection of serum antibodies to herpes simplex virus 1, 2, cytomegalovirus, Epstein-Barr virus, COVID-19. Results: in recipients with HPV-associated skin manifestations, the incidence of COVID-19 was significantly lower than in recipients who did not have them: – 30.4% and 50%, respectively, p=0.011. The incidence of new coronavirus infection did not differ in the groups of patients with cutaneous manifestations caused by herpes simplex viruses type 1 and 2 and without them. Among recipients with Epstein-Barr virus seropositivity, there were significantly fewer cases of COVID-19 compared to seronegative patients – 26.2% and 54.8%, respectively, p=0.0002. Conclusion: HPV-associated dermal manifestations of serum EBV-seropositivity in recipients after kidney transplantation is associated with a lower incidence of moderate and severe COVID-19. Further studies are needed to confirm the possibility of cross-immunity against COVID-19 with other infections. © 2022 JSC Vidal Rus. All rights reserved.
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INTRODUCTION: In recent months, with the spread of COVID 19, the number of kidney transplants from deceased donors has declined significantly in most countries. One of the reasons is the possibility of infection of the recipient with SARS-CoV-2. Determining the risk of transmission of COVID 19 with a donor organ is very important for developing a kidney transplantation policy during a pandemic. MATERIAL AND METHOD: We present cases of kidney transplantation from COVID 19 positive deceased donor to two dialysis patients in single center. Deceased donor: a 45 years old man with diabetes, who had a major hemorrhagic stroke resulting in brain death. He had normal urine output and serum creatinine level for last 24 hours before kidney harvesting. For a few hours after organ harvesting, the donor was diagnosed COVID 19 (retrospective nasopharyngeal swab rRT-PCR which was confirmed by morphological examination and RNA-PCR of specimens from the trachea and bronchus). Recipient 1: a 49 years old man with polycystic kidney disease had been on hemodialysis for 28 months. He was in urgent list because of problems with vascular access. So non identical ABO (0-donor, B-recipient) kidney transplantation from this deceased donor was done in May 2020. Recipient 2: a 45 years old man with polycystic kidney disease on continuous ambulatory peritoneal dialysis (CAPD). was registered on urgent waiting list because of low transport capacity of peritoneum. Kidney transplantation from the same deceased donor was done at the same time. In both cases we completely abandoned any antilymphocytic agents for induction, despite non ABO identical transplantation in one of the recipients and the delayed graft function. Both patients received only basic immunosuppression, including tacrolimus, methylprednisolone and a mycophenolic acid. RESULTS: In first case cold ischemia time was 22 hours. The recipient had delayed graft function with increasing of urine output on day 8 post-transplant. No other deviations from the usual course were seen during hospital stay. The patient was discharge from hospital with serum creatinine level 122 mkmol/L. The cold ischemia time was 21 hours in another patient. Graft function was immediate with a decrease serum creatinine to 92.5 mkmol/L at discharge. Both patients had no febrile and no other symptoms of acute respiratory disease during all hospital stay. No abnormalities on chest X-ray were seen. No serum anti-SARS-CoV-2 IgM and IgG were detected before and during 6 weeks after surgery. Repeated nasopharyngeal swabs rRT-PCR were negative during all the period. Both recipients were discharged for 5 weeks after surgery to prevent out-of-hospital contamination of COVID 19, which would be difficult to differentiate from transmission infection. After 9 months both patients are doing well with no clinical or laboratory signs of COVID-19. CONCLUSION: Today we have no evidence of the possibility of transmission of COVID-19 from a SARS-Cov-2 positive donor to a kidney recipient. We also have no reason to suspect kidney damage by COVID-19 in a deceased donor at normal serum creatinine level. Avoiding the use of anti-lymphocyte drugs for induction of immunosuppression may also reduce the risk of developing COVID19 after transplantation. A careful collection and analysis of such dates is necessary to develop modern practical recommendations for transplant centers.
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INTRODUCTION: In recent months, the number of kidney transplants from deceased donors has declined significantly. One of the reasons is the possibility of infection of the recipient with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Determining the risk of transmission of coronavirus disease 2019 (COVID-19) with a donor organ is very important for developing a kidney transplantation policy during a pandemic. MATERIALS AND METHOD: We present cases of kidney transplantation from COVID-19-positive deceased donors to 2 dialysis patients 49 and 45 years old. One of them was on hemodialysis for 28 months; the other received continuous ambulatory peritoneal dialysis (CAPD). Both patients received only basic immunosuppression, including tacrolimus, methylprednisolone, and mycophenolic acid. No antilymphocyte agents were used for induction therapy. RESULTS: Cold ischemia time was 22 and 21 hours, respectively. One recipient had delayed graft function with increasing of urine output on day 8; another had immediate function. Both patients had no febrile and no other symptoms of acute respiratory disease during their hospital stay. No abnormalities on the chest x-ray were seen. No serum anti-SARS-CoV-2 IgM and IgG were detected before and during 6 weeks after surgery. Repeated nasopharyngeal swabs real-time reverse transcription polymerase chain reaction (rRT-PCR) were negative during the period. Both recipients were discharged 5 weeks after surgery with serum creatinine levels of 122 and 91 mcmol/L, respectively. CONCLUSION: Today we have no evidence of the possibility of transmission of COVID-19 from a SARS-CoV-2 positive donor to a kidney recipient. We also have no reason to suspect kidney damage by COVID-19 in a deceased donor at normal serum creatinine level.