In‐depth virological assessment of kidney transplant recipients with COVID‐19

Benotmane, Ilies; Gautier Vargas, Gabriela; Wendling, Marie‐Josée; Perrin, Peggy; Velay, Aurélie; Bassand, Xavier; Bedo, Dimitri; Baldacini, Clement; Sagnard, Mylene; Bozman, Dogan; Della Chiesa, Margaux; Solis, Morgane; Gallais, Floriane; Cognard, Noëlle; Olagne, Jerome; Delagreverie, Héloïse; Gontard, Louise; Panaget, Baptiste; Marx, David; Heibel, Francoise; Braun, Laura; Moulin, Bruno; Caillard, Sophie; Fafi‐Kremer, Samira

Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has spread widely, causing coronavirus disease 2019 (COVID‐19) and significant mortality. However, data on viral loads and antibody kinetics in immunocompromised populations are lacking. We aimed to determine nasopharyngeal and plasma viral loads via RT‐PCR and SARS‐CoV‐2 serology via ELISA and study their association with severe forms of COVID‐19 and death in kidney transplant recipients. In this study we examined hospitalized kidney transplant recipients with non‐severe (n = 21) and severe (n =19) COVID‐19. SARS‐CoV‐2 nasopharyngeal and plasma viral load and serological response were evaluated based on outcomes and disease severity. Ten recipients (25%) displayed persistent viral shedding 30 days after symptom onset. The SARS‐CoV‐2 viral load of the upper respiratory tract was not associated with severe COVID‐19, whereas the plasma viral load was associated with COVID‐19 severity (p=0.010) and mortality (p=0.010). All patients harbored antibodies the second week after symptom onset that persisted for two months. We conclude that plasma viral load is associated with COVID‐19 morbidity and mortality, whereas nasopharyngeal viral load is not. SARS‐CoV‐2 shedding is prolonged in kidney transplant recipients and the humoral response to SARS‐CoV‐2 does not show significant impairment in this series of transplant recipients.