Liver and/or Kidney Transplantation After SARS-CoV-2 Infection: Prevalence, Short-Term Outcome and Kinetics of Serum IgG Antibodies

Verbeek, Jef; Vrij, Casper; Vermeersch, Pieter; Van Elslande, Jan; Vets, Sofie; Lagrou, Katrien; Vos, Robin; van Cleemput, Johan; Jochmans, Ina; Monbaliu, Diethard; Pirenne, Jacques; Kuypers, Dirk; Nevens, Frederik

BACKGROUND: There is paucity of data on the prevalence, adequate timing and outcome of solid organ transplantation after SARS-CoV-2 infection and the kinetics of IgG antibodies in these patients. METHODS: SARS-CoV-2 anti-nucleocapsid (N) IgG and PCR via nasopharyngeal swab were analyzed in all patients within 24h before liver and/or kidney transplantation. Kinetics of IgG antibodies were analysed and compared with an immune-competent cohort. RESULTS: Between May 1st 2020 and March 18th 2021, 168 patients underwent liver and/or kidney transplantation in our centre, of which 11 (6.54%) patients with previous SARS-CoV-2 infection were identified. Median interval between SARS-CoV-2 infection and transplantation was 4.5 months (range 0.9-11). After a median post-transplant follow-up of 4.9 months, 10 out of 11 patients were alive without clinical signs of viral shedding or recurrent or active infection. One patient without symptom resolution at time of transplantation died after combined liver-kidney transplantation. In 9 out of 11 patients with previously PCR confirmed infection, SARS-CoV-2 anti-N and anti-spike (S) IgG were detectable at day of transplantation. Absolute levels of anti-N and anti-S IgG were positively correlated, declined over time in all patients and were significantly lower compared with immune-competent individuals. All patients remained anti-S IgG positive until last post-transplant follow-up, while three patients became anti-N negative. CONCLUSIONS: We observed an uncomplicated course of liver and/or kidney transplantation after SARS-CoV-2 infection in selected patients. Although having lower absolute IgG antibody levels than immune-competent individuals, all seroconverted patients remained anti-S IgG positive. These encouraging data need validation in larger studies.