Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by SARS-CoV-2 denotes a global health issue. Data regarding COVID-19 incidence in kidney transplant recipients (KTR) are sparse. From 19 March to 19 May 2020, we performed a systematic screening for COVID-19 in KTR. Tests included serum analysis for SARS-CoV-2 antibodies using S protein-based immunofluorescence, anti-SARS-CoV-2 S1 immunoglobulin G (IgG) and immunoglobulin A (IgA) enzyme-linked immunosorbent assays (ELISA), and/or quantitative reverse transcription polymerase chain reaction (qRT-PCR) from nasal-throat swabs. Outpatient serum samples from KTR with PCR confirmed COVID-19, and swab samples from recipients (+donors) undergoing kidney transplantation were analyzed. Out of 223 samples from outpatients, 13 patients were positive with solely anti-SARS-CoV-2-IgA and 3 with both anti-IgA and anti-IgG. In total, 53 patients were symptomatic in the past, but positive results could be found in both symptomatic and asymptomatic patients. After an in depth analysis using immunofluorescence and neutralization tests in 2 KTR, recent COVID-19 infection remained highly suspicious. Apart from outpatient visits, only 5 out of 2044 KTR were symptomatic and tested positive via PCR, of which 4 recovered and one died. All patients showed seroconversion during the course of the disease. This study demonstrated a low seroprevalence in a German KTR cohort, and seroconversion of IgA and IgG after COVID-19 could be demonstrated. Effective containment strategies enabled us to continue our transplant program.
Highlights
The current coronavirus disease 2019 (COVID-19) pandemic is caused by a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has become a worldwide global health issue with rates of infection still increasing
Case series have been reported to have SARS-CoV-2 serologic responses in solid organ recipients (SOT) after COVID-19 [12,13], little is known about the seroprevalence and serological responses in renal transplant patients with COVID-19
By using enzyme-linked immunosorbent assay (ELISA) antibody testing, 13 patients (5.8%) showed a solely positive SARS-CoV-2-immunoglobulin A (IgA) antibody result and three (1.3%) a combined positive IgA and immunoglobulin G (IgG) antibody result
Summary
The current coronavirus disease 2019 (COVID-19) pandemic is caused by a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has become a worldwide global health issue with rates of infection still increasing. In a larger case series of 90 organ transplant recipients, including 43 patients after renal transplantation with COVID-19 from an outbreak in New York, high rates of severe disease (39%) and mortality (24%) were observed [3]. Case series have been reported to have SARS-CoV-2 serologic responses in solid organ recipients (SOT) after COVID-19 [12,13], little is known about the seroprevalence and serological responses in renal transplant patients with COVID-19. The Euroimmun enzyme-linked immunosorbent assay (ELISA) has been established at our hospital and recently received emergency use authorization from the Food and Drug Administration (FDA)
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