Changes in SARS-CoV2–Specific T-Cell Responses After Kidney Transplant

A small study of 13 patients evaluated SARS-CoV2–specific T-cell immune responses in kidney transplant recipients pre- and post-transplantation. The aim was to understand the dynamic association between donor characteristics, induction immunosuppression, and recipient features in the post-transplant period. Results of the study by Ambreen Azhar, MD, MS, and others were presented during the American Transplant Congress 2024.

Three patients were SARS-CoV2 positive and 10 were SARS-CoV2 negative; all were deceased donor kidney transplant recipients. No participants received vaccines during the study period. All participants demonstrated SARS-CoV-2 T-cell immunity during the pretransplantation period.

Post-transplant, three (24%) patients had a loss of immunity. Of these, one received increased immunosuppression due to antibody-mediated rejection; one with pretransplant oncologic chemotherapy exposure had post-transplant failure to thrive; and one with pretransplant biologic exposure from ulcerative colitis had a protracted hospital stay with other infections. One asymptomatic patient who was transplanted in the presence of a positive SARS-CoV-2 nasopharyngeal swab had positive CD8 status at 4 weeks post-transplant. One unvaccinated patient maintained a CD4 immune response despite receiving post-transplant desensitization with plasmapheresis and intravenous immunoglobulins.

In sum, the authors concluded that SARS-CoV2 T-cell responses are largely preserved despite T-cell depletion induction. “Augmented immunosuppression due to rejection and other medical histories may compromise responses and should be considered as factors to target patients for future available prophylactic therapies or augmented vaccination,” they wrote.

Source: Azhar A, Kleiboeker S, Saeed M, et al. Dynamic changes in SARS-CoV2-specific T cell immune response post kidney transplant. Abstract #B054. Presented at the American Transplant Congress 2024; June 1-5, 2024; Philadelphia, Pennsylvania.