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

Scientific paper - Original scientific paper

• Author: Marina Kljajić
• Author: Zoran Sabljić
• Author: Ivana Jurić
• Author: Vesna Furić Čunko
• Author: Renata Žunec
• Author: Marija Burek Kamenarić
• Author: Bojan Jelaković
• Author: Nikolina Bašić-Jukić
• Author's institution: University of Zagreb; School of Medicine; (Department of Internal Medicine)
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract (english)

Background/Objectives: 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.
Methods: 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. Results: 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.
Conclusions: These findings suggest that the SARS-CoV-2 virus has an immunomodulatory effect and may be associated with an increased mortality in this population.

• Keywords (english): COVID-19; HLA; SARS-CoV-2; immunomodulation; transplantation
• Language: english
• Publication type: Scientific paper - Original scientific paper
• Publication status: Published
• Peer review: Peer review
• Publication version: Published version
• Journal title: Journal of Clinical Medicine
• Numbering: vol. 13, no. 8, 2383
• e-ISSN: 2077-0383
• DOI: https://doi.org/10.3390/jcm13082383
• URN:NBN: urn:nbn:hr:105:231441
• Publication: 2024-04-19
• Document URL: https://www.mdpi.com/2077-0383/13/8/2383
• Type of resource: Text
• Access conditions: Open access
• Created on: 2025-03-03 09:07:54