SARS-CoV-2 infection in dialysis and kidney transplant patients: immunological and serological response

J Nephrol. 2022 Apr;35(3):745-759. doi: 10.1007/s40620-021-01214-8. Epub 2022 Jan 24.

Abstract

Background: Dialysis and kidney transplant patients with moderate-severe COVID-19 have a high mortality rate, around 30%, that is similar in the two populations, despite differences in their baseline characteristics. In these groups, the immunology of the disease has been poorly explored.

Methods: Thirty-two patients on dialysis or with kidney transplant and SARS-CoV-2 infection requiring hospitalization (COV group) were included in our study. Lymphocyte subsets, dendritic cell (DC) counts and monocyte activation were studied. SARS-CoV-2 anti-spike/anti-nucleocapsid were monitored, and baseline cytokines and chemokines were measured in 10 patients.

Results: The COV group, compared to healthy subjects and uninfected dialysis/kidney transplant controls, showed lower numbers of CD4 + and CD8 + T cells, Natural-Killer (NK), B cells, plasmacytoid and myeloid DCs, while the proportion of terminally differentiated B-cells was increased. IL6, IL10, IFN-α and chemokines involved in monocyte and neutrophil recruitment were higher in the COV group, compared to uninfected dialysis/kidney transplant controls. Patients with severe disease had lower CD4 + , CD8 + and B-cell counts and lower monocyte HLA-DR expression. Of note, when comparing dialysis and kidney transplant patients with COVID-19, the latter group presented lower NK and pDC counts and monocyte HLA-DR expression. Up to 60 days after symptom onset, kidney transplant recipients showed lower levels of anti-spike antibodies compared to dialysis patients.

Conclusions: During SARS-CoV-2 infection, dialysis and kidney transplant patients manifest immunophenotype abnormalities; these are similar in the two groups, however kidney transplant recipients show more profound alterations of the innate immune system and lower anti-spike antibody response.

Keywords: COVID-19; Hemodialysis; Kidney transplant; Lymphocytes; SARS-CoV-2.

Publication types

  • Research Support, N.I.H., Intramural

MeSH terms

  • COVID-19*
  • HLA-DR Antigens
  • Humans
  • Kidney Transplantation* / adverse effects
  • Renal Dialysis / adverse effects
  • SARS-CoV-2
  • Transplant Recipients

Substances

  • HLA-DR Antigens