AUTHOR=Killian John T. , Houp Julie A. , Burkholder Greer A. , Roman Soto Salomon A. , Killian A. Cozette , Ong Song C. , Erdmann Nathaniel B. , Goepfert Paul A. , Hauptfeld-Dolejsek Vera , Leal Sixto M. , Zumaquero Esther , Nellore Anoma , Agarwal Gaurav , Kew Clifton E. , Orandi Babak J. , Locke Jayme E. , Porrett Paige M. , Levitan Emily B. , Kumar Vineeta , Lund Frances E. TITLE=COVID-19 Vaccination and Remdesivir are Associated With Protection From New or Increased Levels of Donor-Specific Antibodies Among Kidney Transplant Recipients Hospitalized With COVID-19 JOURNAL=Transplant International VOLUME=35 YEAR=2022 URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2022.10626 DOI=10.3389/ti.2022.10626 ISSN=1432-2277 ABSTRACT=

Alloimmune responses in kidney transplant (KT) patients previously hospitalized with COVID-19 are understudied. We analyzed a cohort of 112 kidney transplant recipients who were hospitalized following a positive SARS-CoV-2 test result during the first 20 months of the COVID-19 pandemic. We found a cumulative incidence of 17% for the development of new donor-specific antibodies (DSA) or increased levels of pre-existing DSA in hospitalized SARS-CoV-2-infected KT patients. This risk extended 8 months post-infection. These changes in DSA status were associated with late allograft dysfunction. Risk factors for new or increased DSA responses in this KT patient cohort included the presence of circulating DSA pre-COVID-19 diagnosis and time post-transplantation. COVID-19 vaccination prior to infection and remdesivir administration during infection were each associated with decreased likelihood of developing a new or increased DSA response. These data show that new or enhanced DSA responses frequently occur among KT patients requiring admission with COVID-19 and suggest that surveillance, vaccination, and antiviral therapies may be important tools to prevent alloimmunity in these individuals.