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. 2021 Oct 1;105(10):2175-2183.
doi: 10.1097/TP.0000000000003860.

Prospective Clinical, Virologic, and Immunologic Assessment of COVID-19 in Transplant Recipients

Tina Marinelli  1 , Victor H Ferreira  1 , Matthew Ierullo  1 , Terrance Ku  1 , Les Lilly  1 , S Joseph Kim  1 , Jeffrey Schiff  1 , Aman Sidhu  1 , Michael McDonald  1 , Seyed M Hosseini-Moghaddam  1 , Shahid Husain  1 , Coleman Rotstein  1 , Beata Majchrzak-Kita  1 , Vathany Kulasingam  2 , Atul Humar  1 , Deepali Kumar  1
Affiliations

Prospective Clinical, Virologic, and Immunologic Assessment of COVID-19 in Transplant Recipients

Tina Marinelli et al. Transplantation. .

Abstract

Background: Several studies have described the clinical features of COVID-19 in solid-organ transplant recipients. However, many have been retrospective or limited to more severe cases (hospitalized) and have not routinely included serial virological sampling (especially in outpatients) and immunologic assessment.

Methods: Transplant patients diagnosed with COVID-19 based on a respiratory sample PCR were prospectively followed up to 90 d. Patients provided consent for convalescent serum samples and serial nasopharyngeal swabs for SARS-CoV-2 antibody (antinucleoprotein and anti-RBD) and viral load, respectively.

Results: In the 161 SOT recipients diagnosed with COVID-19, the spectrum of disease ranged from asymptomatic infection (4.3%) to hospitalization (60.6%), supplemental oxygen requirement (43.1%), mechanical ventilation (22.7%), and death (15.6%). Increasing age (OR, 1.031; 95% CI, 1.001-1.062; P = 0.046) and ≥2 comorbid conditions (OR, 3.690; 95% CI, 1.418-9.615; P = 0.007) were associated with the need for supplemental oxygen. Allograft rejection was uncommon (3.7%) despite immunosuppression modification. Antibody response at ≥14 d postsymptoms onset was present in 90% (anti-RBD) and 76.7% (anti-NP) with waning of anti-NP titers and stability of anti-RBD over time. Median duration of nasopharyngeal positivity was 10.0 d (IQR, 5.5-18.0) and shedding beyond 30 d was observed in 6.7% of patients. The development of antibody did not have an impact on viral shedding.

Conclusions: This study demonstrates the spectrum of COVID-19 illness in transplant patients. Risk factors for severe disease are identified. The majority form antibody by 2 wk with differential stability over time. Prolonged viral shedding was observed in a minority of patients. Reduction of immunosuppression was a safe strategy.

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Figures

FIGURE 1.
FIGURE 1.
Modified WHO progression scale of transplant recipients with coronavirus disease 2019. Number of solid-organ transplant recipients with modified WHO severity scores. 1–3 (green bars): ambulatory mild disease, 4–5 (yellow bars): hospitalized moderate disease, 6–9 (orange bars): hospitalized severe disease, and 10 (red bars): death. WHO, World Health Organization.
FIGURE 2.
FIGURE 2.
Antibody responses in solid-organ transplant recipients. Antispike RBD (A) and anti-NP (B) antibody responses in n = 60 solid-organ transplant recipients. Dashed horizontal lines indicate cutoff for positivity of each test. The fraction of individuals positive at each time period is also denoted above each box plot. All serum samples were ≥14 d postsymptom onset. Plots indicate median and interquartile range. NP, nucleoprotein; RBD, spike receptor-binding domain.
FIGURE 3.
FIGURE 3.
Viral loads in SOTRs. A, Viral loads measured in n = 30 SOTRs. Each dot corresponds to a nasopharyngeal swab result collected during the range of days from symptom onset shown on the x-axis. Box and whisker plots show the median plus the interquartile range for each date interval. B, Percent of swabs tested with a detectable viral load in the days following symptom onset. C, Peak viral load for each patient with at least 1 detectable viral load. Bars show median and interquartile range. Dashed horizontal line indicated the limit of quantification. D, Duration of detectable viral load for individual patients in the study. SOTR, solid-organ transplant recipient.
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References

    1. Pereira MR, Mohan S, Cohen DJ, et al. . COVID-19 in solid organ transplant recipients: initial report from the US epicenter. Am J Transplant. 2020;20:1800–1808. - PMC - PubMed
    1. Kates OS, Haydel BM, Florman SS, et al. . Coronavirus disease 2019 in solid organ transplant: a multicenter cohort study. Clin Infect Dis. [Epub ahead of print. August 7, 2020]. doi:10.1093/cid/ciaa1097 - PMC - PubMed
    1. Søfteland JM, Friman G, von Zur-Mühlen B, et al. . COVID-19 in solid organ transplant recipients: a national cohort study from Sweden. Am J Transplant. 2021;21:2762–2773. - PMC - PubMed
    1. Roberts MB, Izzy S, Tahir Z, et al. . COVID-19 in solid organ transplant recipients: dynamics of disease progression and inflammatory markers in ICU and non-ICU admitted patients. Transpl Infect Dis. 2020;22:e13407. - PMC - PubMed
    1. Chaudhry ZS, Williams JD, Vahia A, et al. . Clinical characteristics and outcomes of COVID-19 in solid organ transplant recipients: a cohort study. Am J Transplant. 2020;20:3051–3060. - PMC - PubMed

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