Immunomodulatory Effect of COVID-19 on HLA-Antibody Profile in Renal Transplant Recipients

• Published in: Journal of clinical medicine 2024-04, Vol.13 (8), p.2383
• Main Authors: Kljajic, Marina, Sabljic, Zoran, Juric, Ivana, Furic Cunko, Vesna, Zunec, Renata, Burek Kamenaric, Marija, Jelakovic, Bojan, Basic-Jukic, Nikolina
• Format: Article
• Language: English
• Subjects: COVID-19; Cytomegalovirus; Epstein-Barr virus; Graft rejection; Health aspects; Histocompatibility antigens; HLA histocompatibility antigens; Immune response; Kidneys; Risk factors; Transplantation; Viral infections
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm13082383

The novel coronavirus disease 2019 (COVID-19) has led to significant morbidity and mortality among kidney transplant recipients. SARS-CoV-2 has been hypothesized to cause an unusual immunological dysregulation triggering alloimmunity and leading to graft rejection. This prospective observational cohort study assessed 321 kidney transplant recipients who had COVID-19 infection. After the infection, patients' sera were tested for the presence of anti-HLA de novo DSA and non-DSA specificities. Logistic regression analysis and a stepwise multivariable logistic regression analysis were used to analyze the independent risk factors associated with the development of antibodies, adjusting for known confounders. The variables evaluated were acute COVID-19 characteristics (i.e., presentation, and need for hospitalization), demographic characteristics (i.e., age, gender, and primary renal disease), clinical characteristics (i.e., various comorbidities), and post-COVID-19 sequelae. Anti-HLA de novo DSA developed in 18.7% of patients, while anti-HLA class I and class II non-DSA antibodies developed de novo in 84 (26.3%) and 83 (25.9%) patients, respectively. The development of DSA, HLA-DQ, and HLA-DR antibodies was predicted by the history of graft rejection. Obesity appeared to be protective against the emergence of de novo DSA. De novo DSA and HLA-DR antibody formation was positively linked with intravenous immunoglobulin use, CMV-hyperimmune globulin use, and decreased doses of immunosuppression during acute infection. Better allograft function during the acute disease was a protective factor against the formation of HLA-DQ and HLA-DR antibodies. Positive predictors of de novo DSA development were graft biopsy and the reactivation of EBV after infection. These findings suggest that the SARS-CoV-2 virus has an immunomodulatory effect and may be associated with an increased mortality in this population.