Abstract
Background: Dialysis and kidney transplant patients with moderate-severe COVID-19 have a high mortality rate, around 30%, that is similar in the two populations, despite differences in their baseline characteristics. In these groups, the immunology of the disease has been poorly explored.
Methods: Thirty-two patients on dialysis or with kidney transplant and SARS-CoV-2 infection requiring hospitalization (COV group) were included in our study. Lymphocyte subsets, dendritic cell (DC) counts and monocyte activation were studied. SARS-CoV-2 anti-spike/anti-nucleocapsid were monitored, and baseline cytokines and chemokines were measured in 10 patients.
Results: The COV group, compared to healthy subjects and uninfected dialysis/kidney transplant controls, showed lower numbers of CD4 + and CD8 + T cells, Natural-Killer (NK), B cells, plasmacytoid and myeloid DCs, while the proportion of terminally differentiated B-cells was increased. IL6, IL10, IFN-α and chemokines involved in monocyte and neutrophil recruitment were higher in the COV group, compared to uninfected dialysis/kidney transplant controls. Patients with severe disease had lower CD4 + , CD8 + and B-cell counts and lower monocyte HLA-DR expression. Of note, when comparing dialysis and kidney transplant patients with COVID-19, the latter group presented lower NK and pDC counts and monocyte HLA-DR expression. Up to 60 days after symptom onset, kidney transplant recipients showed lower levels of anti-spike antibodies compared to dialysis patients.
Conclusions: During SARS-CoV-2 infection, dialysis and kidney transplant patients manifest immunophenotype abnormalities; these are similar in the two groups, however kidney transplant recipients show more profound alterations of the innate immune system and lower anti-spike antibody response.
Keywords: COVID-19; Hemodialysis; Kidney transplant; Lymphocytes; SARS-CoV-2.
【저자키워드】 COVID-19, SARS-CoV-2, Lymphocytes, Hemodialysis, kidney transplant, 【초록키워드】 immunology, SARS-CoV-2, Cytokines, Lymphocytes, Hospitalization, T cells, SARS-COV-2 infection, neutrophil, monocyte HLA-DR, B cells, IL6, Lymphocyte subsets, cytokine, chemokines, CD4, CD8, chemokine, dialysis, monocyte, innate immune system, lymphocyte, Hemodialysis, Patient, expression, patients, anti-spike antibodies, dendritic cell, kidney transplant, anti-spike antibody, kidney transplant recipient, B-cell, kidney transplant recipients, severe disease, IFN-α, symptom onset, two groups, baseline characteristics, Monocyte activation, healthy subjects, alteration, anti-spike antibody response, neutrophil recruitment, high mortality rate, IL10, uninfected, DCs, populations, controls, involved, proportion, the disease, groups, healthy subject, were measured, baseline, moderate-severe, patients with COVID-19, terminally differentiated, was increased, 【제목키워드】 serological response, immunological,