Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021;8(2):127-139.
doi: 10.1007/s40472-021-00322-5. Epub 2021 Mar 4.

Immune Responses to SARS-CoV-2 in Solid Organ Transplant Recipients

Varun K Phadke  1   2 , Nicholas Scanlon  2 , Stanley C Jordan  3 , Nadine G Rouphael  2
Affiliations
Review

Immune Responses to SARS-CoV-2 in Solid Organ Transplant Recipients

Varun K Phadke et al. Curr Transplant Rep. 2021.

Abstract

Purpose of review: Coronavirus disease 2019 (COVID-19) is caused by a complex interplay between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) dynamics and host immune responses. Hosts with altered immunity, including solid organ transplant recipients, may be at increased risk of complications and death due to COVID-19. A synthesis of the available data on immune responses to SARS-CoV-2 infection is needed to inform therapeutic and preventative strategies in this special population.

Recent findings: Few studies have directly compared immune responses to SARS-CoV-2 between transplant recipients and the general population. Like non-transplant patients, transplant recipients mount an exuberant inflammatory response following initial SARS-CoV2 infection, with IL-6 levels correlating with disease severity in some, but not all studies. Transplant recipients display anti-SARS-CoV-2 antibodies and activated B cells in a time frame and magnitude similar to non-transplant patients-limited data suggest these antibodies can be detected within 15 days of symptom onset and may be durable for several months. CD4+ and CD8+ T lymphopenia, a hallmark of COVID-19, is more profound in transplant recipients, but SARS-CoV-2-reactive T cells can be detected among patients with both mild and severe disease.

Summary: The limited available data indicate that immune responses to SARS-CoV-2 are similar between transplant recipients and the general population, but no studies have been sufficiently comprehensive to understand nuances between organ types or level of immunosuppression to meaningfully inform individualized therapeutic decisions. The ongoing pandemic provides an opportunity to generate higher-quality data to support rational treatment and vaccination strategies in this population.

Keywords: COVID-19; Immune response; SARS-CoV-2; Solid organ transplant; Vaccine.

PubMed Disclaimer

Conflict of interest statement

Conflict of InterestDr. Phadke was supported in part by Imagine, Innovate, and Impact (I3) Funds from the Emory University School of Medicine and through the Georgia CTSA NIH award (UL1-TR002378). Dr. Scanlon was supported by the NIH R38 Stimulating Access to Research in Residency (StARR) grant through the NIH/NIAID (5R38AI140299-02). Dr. Jordan reports receiving grants and non-financial support from CSL Behring during the preparation of this manuscript, and grants and personal fees from CSL Behring, Hansa Biopharma, Regeneron, and Amplyx outside the submitted work. Dr. Jordan has patents for the use of IL-6 inhibitors for desensitization and treatment of antibody-mediated rejection in transplant recipients, the use of clazakizumab to desensitize and improve renal transplantation in HLA-sensitized patients and to treat chronic antibody-mediated rejection of organ transplants, and the use of calcineurin inhibitor–free CTLA4-Ig with anti-IL-6/IL-6R for long-term immunosuppression in solid organ transplant recipients, all licensed to CSL Behring. All are outside the submitted work. Dr. Rouphael was supported by the Immunophenotyping Assessment in a COVID-19 Cohort (IMPACC) grant through the NIH/DAIT (5U19AI090023).

References

    1. Tay MZ, Poh CM, Renia L, MacAry PA, Ng LFP. The trinity of COVID-19: immunity. inflammation and intervention. Nat Rev Immunol. 2020;20(6):363–374. doi: 10.1038/s41577-020-0311-8.. - DOI - PMC - PubMed
    1. • Fung M, Babik JM. COVID-19 in immunocompromised hosts: what we know so far. Clin Infect Dis. 2020. 10.1093/cid/ciaa863Comprehensive review of published studies of COVID-19 in all types of immunocompromised hosts, including solid organ transplant recipients. - PMC - PubMed
    1. Cravedi P, Mothi SS, Azzi Y, Haverly M, Farouk SS, Perez-Saez MJ, et al. COVID-19 and kidney transplantation: results from the TANGO International Transplant Consortium. Am J Transplant. 2020;20(11):3140–3148. doi: 10.1111/ajt.16185. - DOI - PMC - PubMed
    1. Pereira MR, Mohan S, Cohen DJ, Husain SA, Dube GK, Ratner LE, et al. COVID-19 in solid organ transplant recipients: initial report from the US epicenter. Am J Transplant. 2020;20(7):1800–1808. doi: 10.1111/ajt.15941. - DOI - PMC - PubMed
    1. Kates OS, Haydel BM, Florman SS, Rana MM, Chaudhry ZS, Ramesh MS, et al. COVID-19 in solid organ transplant: a multi-center cohort study. Clin Infect Dis. 2020. 10.1093/cid/ciaa1097. - PubMed

LinkOut - more resources