Prevalence and Predictors of SARS‐CoV‐2 Antibodies among Solid Organ Transplant Recipients with Confirmed Infection

Burack, Daniel; Pereira, Marcus R.; Tsapepas, Demetra S.; Harren, Patricia; Farr, Maryjane A.; Arcasoy, Selim; Cohen, David J.; Mohan, Sumit; Emond, Jean C.; Hod, Eldad A.; Verna, Elizabeth C.

It remains uncertain whether immunocompromised patients including solid organ transplant (SOT) recipients will have a robust antibody response to SARS‐CoV‐2 infection. We enrolled all adult SOT recipients at our center with confirmed SARS‐CoV‐2 infection who underwent antibody testing with a single commercially available anti‐nucleocapsid antibody test at least 7 days after diagnosis in a retrospective cohort. 70 SOT recipients were studied (56% kidney, 19% lung, 14% liver +/‐ kidney, and 11% heart +/‐ kidney recipients). 36 (51%) had positive anti‐nucleocapsid antibody testing, and 34 (49%) were negative. Recipients of a kidney allograft were less likely to have positive antibody testing compared those who did not receive a kidney (p=0.04). In the final multivariable model, the years from transplant to diagnosis (OR 1.26, p=0.002) and baseline immunosuppression with more than 2 agents (OR 0.26, p=0.03) were significantly associated with the antibody test result, controlling for kidney transplantation. In conclusion, among SOT recipients with confirmed infection, only 51 % of patients had detectable anti‐nucleocapsid antibodies, and transplant‐related variables including the level and nature of immunosuppression are important predictors. These findings raise the concern that SOT recipients with COVID‐19 may be less likely to form SARS‐CoV‐2 antibodies.