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. 2022 Jun;24(3):e13827.
doi: 10.1111/tid.13827. Epub 2022 Apr 6.

Reinfection with SARS-CoV-2 in solid-organ transplant recipients: Incidence density and convalescent immunity prior to reinfection

Stephen Morris  1 , Shweta Anjan  1   2 , Suresh Pallikkuth  3 , Paola Frattaroli  4 , Steve Courel  5 , Anmary Fernandez  6 , Akina Natori  7 , Lilian Abbo  1   2 , Savita Pahwa  3 , Giselle Guerra  2   8 , Yoichiro Natori  1   2
Affiliations

Reinfection with SARS-CoV-2 in solid-organ transplant recipients: Incidence density and convalescent immunity prior to reinfection

Stephen Morris et al. Transpl Infect Dis. 2022 Jun.

Abstract

Background: Long-term protective immunity to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains poorly characterized, particularly in solid organ transplant (SOT) patients.

Method: We determined the incidence density of SARS-CoV-2 reinfection in a cohort of adult SOT recipients initially infected between March 1st, 2020 and March 30th, 2021 and included those with initial infection before or after transplantation. Incidence density was the total cases divided by total days after initial diagnosis with active graft.

Results: Of 210 infected recipients, five (2.4%) developed reinfection, including two who had received full mRNA vaccination, but none developed hypoxia. The incidence density for reinfection was 9.4 (95% confidence interval [CI] 3.9-22.6) and for primary infection the density was 9.1 (95% CI 7.9-10.5) cases/100,000 patient days. Two recipients had immunity evaluated in the weeks prior to reinfection, by measuring immunoglobulin-G (IgG) antibody titer to the SARS-CoV-2 receptor binding domain and virus-specific CD4+ and CD8+ T-cell reactivity following stimulation with SARS-CoV-2 peptide pools. Both mounted virus specific CD4 T-cell responses prior to reinfection (1.19% and 0.28% of total CD4 T cells) and both had reactive IgG testing (1.30 and 4.99 signal/cut off ratio).

Conclusions: This suggests that SOT recipients infected with SARS-CoV-2 remain at high risk for reinfection even after generating cellular and humoral immune responses.

Keywords: COVID-19; SARS-CoV-2; reinfection; solid organ transplant.

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Conflict of interest statement

The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

Figures

FIGURE 1
FIGURE 1
Flow cytometry. (A) CD4+CD69+CD40L, B: CD8+CD69+CD137. Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2‐specific T cells were identified by flow cytometry using activation‐induced marker (AIM) assay after 24 hours stimulation of peripheral blood mononuclear cell with non‐spike (R), and spike (S) megapools for CD4 T cells and CD8 A and CD8 B megapools for CD8 T cells. SARS‐CoV‐2‐specific (A) CD4 T cells were identified as frequencies of CD69+, CD40L+ cells and (B) CD8 T cells as frequencies of CD69+ CD137+ cells
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