Kidney transplant recipients experience immune-insufficiency during acute COVID-19, which may explain the low rates of acute rejection among these patients even with reduced immunosuppression, according to a recently published study.“Immunosuppressed kidney transplant recipients (KTRs) are largely reported to have poor outcomes compared to non-transplant patients. Since immunosuppression could inhibit the development of protective anti-COVID-19 immunity, most centers have empirically reduced anti-rejection immunosuppression in KTRs with COVID-19 from the onset of the pandemic,” Zeguo Sun, from the department of medicine at the Icahn School of Medicine at Mount Sinai, and colleagues wrote. They added, “Understanding immune signatures from the peripheral blood of KTRs during and after COVID-19 infection would provide insight into management of immunosuppression during acute disease.”Source: Adobe StockSun and colleagues examined the blood of 64 adult kidney transplant recipients infected with COVID-19 between May 2020 and May 2021 to determine best management of immunosuppression during acute illness.The cohort included 31 acute cases (<4 weeks from diagnosis) and 33 post-acute cases (>4 weeks). Clinical data were derived by chart review. Researchers collected a single blood sample (2.5 mL to 5 mL) from patients for peripheral blood transcriptome analysis in a PAXgene tube with RNA stabilization reagents. Researchers then performed RNA sequencing to assess transcriptome changes.Analyses of blood in acute cases revealed some genes were over-expressed and others were under-expressed with higher COVID-19 severity. Researchers identified increased expression of genes involved in innate immune pathways but decreased expression of genes involved in the initiation of adaptive immune pathways.Compared with post-acute cases, enriched pathways showed “normalization” after more than 4 weeks, implying recovery of adaptive immune system activation. Researchers noted the analysis on non-KTRs with COVID-19 showed substantial overlap with KTRs in these functions.“We found that KTRs with COVID-19 showed signatures of immune-insufficiency in their peripheral blood that was even worse with severe illness — for instance among patients in the intensive care unit. We also noted that there were signals of recovery in the post-acute cases pointing to a temporary phenomenon during acute illness,” Madhav C. Menon, MBBS, MD, co-author from Yale University School of Medicine and Icahn School of Medicine at Mount Sinai, said in a press release. “As this pandemic continues to affect KTRs, our collaborative findings will provide insights to the transplant community to manage anti-rejection medicines during acute COVID-19.”Reference:Study provides insights into how the immune system of kidney transplant recipients responds to COVID-19. https://www.newswise.com/coronavirus/study-provides-insights-into-how-the-immune-system-of-kidney-transplant-recipients-responds-to-covid-19/?article_id=777158&sc=dwhr&xy=10007438/?ad2f=1. Published Aug. 30, 2022. Accessed Aug. 30, 2022.