• Asthma
• Autoimmunity
• Chronic disease
• Chronic obstructive pulmonary disease
• Corticosteroids
• Immunosuppression
• Infection risk
• Malignancy
• Safety
• Transplantation

• Humans
• Respiratory Tract Infections/virology
• Respiratory Tract Infections/epidemiology
• Respiratory Tract Infections/drug therapy
• Adrenal Cortex Hormones/therapeutic use
• Adrenal Cortex Hormones/adverse effects
• Disease Susceptibility
• Virus Diseases
• Asthma
• Pulmonary Disease, Chronic Obstructive/drug therapy
• Viruses/drug effects
• Viruses/classification
• Glucocorticoids/therapeutic use
• Glucocorticoids/adverse effects

• COVID-19
• anxiety
• behavior
• glycemic control
• islet transplantation
• pancreas transplantation
• stress
• type 1 diabetes

• Female
• Humans
• Male
• Anxiety
• Blood Glucose
• Blood Glucose Self-Monitoring
• Cross-Sectional Studies
• Diabetes Mellitus, Type 1/complications
• Diabetes Mellitus, Type 1/surgery
• Glycemic Control
• Insulin-Secreting Cells
• Islets of Langerhans Transplantation
• Pandemics
• Public Health

• COVID-19
• ESKD
• Nationwide Inpatient Sample
• advanced chronic kidney disease
• dialysis
• in-hospital mortality
• kidney transplant recipient
• morbidity

• COVID- 19
• SARS-CoV-2
• immunosuppressed
• infection
• kidney transplant
• vaccine

• COVID-19
• SARS-CoV-2
• transplantation

• nephrology
• epidemiology

• COVID-19/epidemiology
• COVID-19 Testing
• Humans
• Kidney Diseases
• Pandemics/prevention & control
• SARS-CoV-2

• Autonomy
• beneficence
• ethics
• kidney transplant
• vaccination

Vaccination is an effective strategy for preventing SARS-CoV-2 infection and associated mortality. Renal Transplant Recipients (RTRs) are vulnerable to acquiring infection and high mortality due to their immunocompromised state. Varying responses to the different vaccines, depending on types of vaccines and population, have been reported. Vaccines supply is also limited. The current study evaluated the seroconversion rate after SARS-CoV-2 infection and 2 doses of either COVAXIN™ or COVISHIELD™ vaccination in RTR.

The serum anti-SARS-CoV-2 spike protein neutralizing antibody titer was measured in 370 RTRs who acquired SARS-CoV-2 infection (n=172), yet not vaccinated; and those vaccinated with COVAXIN™ (n=78), and COVISHIELD™ (n=120) by chemiluminescence microparticle immunoassay methods from serum.

Overall, the seroconversion rate either after vaccination or infection was 85.13% (315/370). The vaccine-associated seroconversion was 80.30% (159/198). SARS-CoV-2 infection-associated seroconversion was 90.69% (156/172), COVISHIELD™ associated seroconversion was 79.2% (95/120), and COVAXIN™ associated seroconversion was 82.05% (64/78). The median IgG titer in the SARS-CoV-2 infection group was 646.50 AU/ml (IQR: 232.52-1717.42), in the COVAXIN™ group was 1449.75 AU/ml (IQR: 400.0-3068.55), and the COVISHIELD™ vaccination group was 1500.51 AU/ml (IQR: 379.47-4938.50). The seroconversion rate and antibody titers were similar irrespective of the place of sampling. Patient’s age-associated seroconversion in <45 years was 88.01% (213/242), 45.1-60 years was 83.18% (94/113), and > 60 years was 58.3% (7/12).

Both infection and vaccination induce robust antibody formation in RTRs. The seroconversion rate after SARS-CoV-2 infection was higher but with a lower antibody titer than vaccines. The vaccines, COVAXIN™ and COVISHIELD™, induce more elevated antibody titers than natural infection. The seroconversion rate and antibody titer in Indian RTRs appears to be better than in the western population, irrespective of their vaccination status.

• Allografts
• COVID-19/prevention & control
• COVID-19 Vaccines
• Humans
• Immunoglobulin G
• Kidney Transplantation
• Middle Aged
• SARS-CoV-2
• Seroconversion
• Tertiary Care Centers
• Vaccination
• Vaccines, Inactivated

The COVID‐19 pandemic has caused significant morbidity and mortality in solid organ transplant (SOT) recipients. However, it remains unclear whether the risk factor for SOT patients is the immunosuppression inherent to transplantation versus patient comorbidities.

We reviewed outcomes in a cohort of SOT (n = 129) and non‐SOT (NSOT) patients (n = 708) admitted to the University of California, Los Angeles for COVID‐19 infection. Data analyses utilized multivariate logistic regression to evaluate the impact of patient demographics, comorbidities, and transplant status on outcomes. SOT patients were analyzed by kidney SOT (KSOT) versus nonkidney SOT (NKSOT) groups.

SOT and NSOT patients with COVID‐19 infection differed in terms of patient age, ethnicity, and comorbidities. NKSOT patients were the most likely to experience death, with a mortality rate of 16.2% compared with 1.8% for KSOT and 8.3% for NSOT patients (p = .013). Multivariable analysis of hospitalized patients revealed that patient age (odds ratio [OR] 2.79, p = .001) and neurologic condition (OR 2.66, p < .001) were significantly associated with mortality. Analysis of ICU patients revealed a 2.98‐fold increased odds of death in NKSOT compared with NSOT patients (p = .013).

This study demonstrates the importance of transplant status in predicting adverse clinical outcomes in patients hospitalized or admitted to the ICU with COVID‐19, especially for NKSOT patients. Transplant status and comorbidities, including age, could be used to risk stratify patients with COVID‐19. This data suggests that immunosuppression contributes to COVID‐19 disease severity and mortality and may have implications for managing immunosuppression, especially for critically ill patients admitted to the ICU.

• Covid-19
• comorbidities
• solid organ transplant

• clinical research/practice
• infection and infectious agents - viral
• infection and infectious agents - viral: SARS-CoV-2/COVID-19
• infectious disease
• kidney transplantation/nephrology

Glucocorticoids (GCs) have been the mainstay of immunosuppressive therapy in solid organ transplantation (SOT) for decades, due to their potent effects on innate immunity and tissue protective effects. However, some SOT centers are reluctant to administer GCs long-term because of the various related side effects. This review summarizes the advantages and disadvantages of GCs in SOT. PubMed and Scopus databases were searched from 2011 to April 2021 using search syntaxes covering “transplantation” and “glucocorticoids”. GCs are used in transplant recipients, transplant donors, and organ perfusate solution to improve transplant outcomes. In SOT recipients, GCs are administered as induction and maintenance immunosuppressive therapy. GCs are also the cornerstone to treat acute antibody- and T-cell-mediated rejections. Addition of GCs to organ perfusate solution and pretreatment of transplant donors with GCs are recommended by some guidelines and protocols, to reduce ischemia-reperfusion injury peri-transplant. GCs with low bioavailability and high potency for GC receptors, such as budesonide, nanoparticle-mediated targeted delivery of GCs to specific organs, and combination use of dexamethasone with inducers of immune-regulatory cells, are new methods of GC application in SOT patients to reduce side effects or induce immune-tolerance instead of immunosuppression. Various side effects involving different non-targeted organs/tissues, such as bone, cardiovascular, neuromuscular, skin and gastrointestinal tract, have been noted for GCs. There are also potential drug-drug interactions for GCs in SOT patients.

• Corticosteroids
• Glucocorticoids
• Solid organ transplantation
• Liver
• Kidney
• Heart
• Lung

The adverse impact of Coronavirus disease 2019 (COVID-19) on kidney function has been reported since the global pandemic. The burden of COVID-19 on kidney transplant recipients, however, has not been systematically analyzed. A systematic review and meta-analysis with a random-effect model was conducted to explore the rate of mortality, intensive care unit admission, invasive mechanical ventilation, acute kidney injury, kidney replacement therapy and graft loss in the adult kidney transplant population with COVID-19. Sensitivity analysis, subgroup analysis and meta-regression were also performed. Results: we demonstrated a pooled mortality rate of 21% (95% CI: 19−23%), an intensive care unit admission rate of 26% (95% CI: 22–31%), an invasive ventilation rate among those who required intensive care unit care of 72% (95% CI: 62–81%), an acute kidney injury rate of 44% (95% CI: 39–49%), a kidney replacement therapy rate of 12% (95% CI: 9–15%), and a graft loss rate of 8% (95% CI: 5–15%) in kidney transplant recipients with COVID-19. The meta-regression indicated that advancing age is associated with higher mortality; every increase in age by 10 years was associated with an increased mortality rate of 3.7%. Regional differences in outcome were also detected. Further studies focused on treatments and risk factor identification are needed.

• acute kidney injury
• coronavirus disease 2019
• graft loss
• kidney replacement therapy
• mortality

• renal replacement therapy
• risk factors
• sars-cov-2

• Acute Kidney Injury/epidemiology
• Acute Kidney Injury/mortality
• COVID-19/epidemiology
• COVID-19/mortality
• Cardiovascular Diseases/epidemiology
• Cardiovascular Diseases/mortality
• Comorbidity
• Diabetes Mellitus/epidemiology
• Diabetes Mellitus/mortality
• Humans
• Kidney Transplantation/adverse effects
• Neoplasms/epidemiology
• Neoplasms/mortality
• Risk Factors
• SARS-CoV-2/isolation & purification
• Transplant Recipients

• Antibodies, Viral/blood
• COVID-19/epidemiology
• France/epidemiology
• Humans
• Kidney Transplantation
• SARS-CoV-2/immunology
• Seroepidemiologic Studies

• economics
• ethics
• ethics < quality of life
• legal aspects < quality of life
• other < kidney clinical

• COVID-19
• COVID-19 Vaccines
• Humans
• Kidney Transplantation
• SARS-CoV-2
• Vaccination

• COVID-19
• ESKD
• SARS-CoV-2
• antibody
• hemodialysis
• neutralization assay

• MR/R008698/1 Medical Research Council

Chronic immunosuppression is associated with an increased risk of opportunistic infections. Although kidney transplant recipients with coronavirus disease 2019 (COVID-19) have higher mortality than the general population, data on their risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are unknown.

A recent single-center screening study from the UK (Transplantation. 2021 Jan 1;105(1):151–7) showed that 89 (10.4%) of 855 consecutive kidney transplant recipients tested positive for SARS-CoV-2 antibodies. Risk factors for infection included a nonwhite background, diabetes, and a history of allograft rejection. Risk factors for mortality in individuals who developed COVID-19 were older age and receiving steroids.

This study shows that the rate of SARS-CoV-2 infection in kidney transplant recipients is similar to the one observed in the general population in the same area (13%), indicating that transplant recipients are not at increased risk of COVID-19. However, the investigators raise the interesting point that since transplant individuals were advised to shelter earlier than the general population, they may be in fact more susceptible. This statement is hard to substantiate, but the identification of specific risk factors for infection and poor outcomes is crucial to tailor strategies to prevent spread of the infection. This is particularly important, considering that kidney transplant recipients may be at increased risk of prolonged viral spread and in-host viral mutations, making them not just a particularly fragile population for COVID-19 but also a potentially major source of further contagions.

• Acute rejection
• Immunology
• Renal transplantation
• SARS-CoV2
• Vaccine

• COVID-19
• Immune response
• SARS-CoV-2
• Solid organ transplant
• Vaccine

• R38 AI140299 NIAID NIH HHS
• U19 AI090023 NIAID NIH HHS
• UL1 TR002378 NCATS NIH HHS
• National Center for Advancing Translational Sciences
• National Institute of Allergy and Infectious Diseases
• National Institutes of Health