Chronic Active Antibody-Mediated Rejection Following COVID-19 Infection in a Kidney Transplant Recipient: A Case Report

Abuzeineh, Mohammad; Tariq, Anam; Rosenberg, Avi Z.; Brennan, Daniel C.

doi:10.1016/j.transproceed.2020.10.050

Cited by 16 publications

(42 citation statements)

References 17 publications

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“…It has been documented that COVID-19 infection could induce anti-HLA Abs development in solid organ transplanted recipients. 13,15 This effect is most likely because of reducing the dose of immunosuppressant medications taken by patients to help overcome COVID-19 infection. In such cases, patients' immune system becomes more competent to mount an immune response to the transplanted organ.…”

Section: Discussionmentioning

confidence: 99%

“…12 Any change in the anti-HLA Abs pool in potential solid organ transplant recipients can dramatically affect the flow cytometric cross matching (FCXM) and the success of transplants as even low incidences of anti-HLA Abs are shown to induce solid organs rejection. 11 Few publications have documented the formation of anti-HLA Abs and DSA in some solid-organ transplant recipients after COVID-19 or Pseudomonas aeruginosa infections, [13][14][15][16] that may cause chronic active Ab-mediated rejection (AMR). 15 In this article, we present the first case report of a patient on a renal transplant waiting list with no history of sensitization, developing dnDSA and de novo non-DSA following COVID-19 vaccination.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

SARS Cov‐2 vaccination induces de novo donor‐specific HLA antibodies in a renal transplant patient on waiting list: A case report

Abu‐Khader

Wang

Berka

et al. 2021

HLA

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The ability of COVID-19 vaccination to induce anti-HLA antibodies (Abs) formation in renal transplant candidates is not well studied. A 42-year-old man on a renal transplant waitlist, with no sensitization history, was tested for DSA before and after COVID-19 vaccination. Patient has consistently tested negative for COVID-19 virus. Eighteen days after receiving first dose of mRNAbased vaccine, flow cytometry crossmatch (FCXM) was strongly positive with de novo donor-specific Ab (dnDSA) against B57 and de novo non-DSA against B58. Before vaccination, preliminary FCXM was negative with no anti-HLA Abs. This event prompted the transplant team to cancel the surgery. COVID-19 vaccination could be associated with anti-HLA Abs formation in renal patients on waitlists that could affect future transplantability.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

SARS Cov‐2 vaccination induces de novo donor‐specific HLA antibodies in a renal transplant patient on waiting list: A case report

Abu‐Khader

Wang

Berka

et al. 2021

HLA

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“…A few cases of the glomerular disease have been reported, most commonly collapsing glomerulopathy. Other cases included minimal change disease, anti‐GBM disease, infection‐associated glomerulonephritis, membranous glomerulopathy, ANCA‐associated vasculitis and other less frequent findings, 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 summarized in Table 5 . Various findings from different groups may indicate diverse problems present in specific populations.…”

Section: Discussionmentioning

confidence: 99%

Histopathologic findings on indication renal allograft biopsies after recovery from acute COVID‐19

Jukić

Čorić

Bulimbašić

et al. 2021

Clinical Transplantation

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Current knowledge on histopathological changes occurring after COVID‐19 in transplanted kidneys is limited. Herein, we present renal allograft pathology findings in patients recovered from COVID‐19. Six patients underwent indication biopsy, and one required allograft nephrectomy after acute COVID‐19. Demographic data, clinical characteristics, and laboratory findings were recorded. The histopathological analysis included light microscopy, immunostaining, and electron microscopy. Five patients were hospitalized for acute COVID‐19, and all were diagnosed with imaging‐confirmed pneumonia, one requiring mechanical ventilation, and two requiring dialysis. Two patients had mild form. Histopathologic examination of renal allograft specimens revealed collapsing, perihilar, tip‐lesion and secondary FSGS in one patient each. One patient had borderline acute cellular rejection, and two had chronic antibody‐mediated rejection. Histopathologic changes of glomerular tufts were accompanied by acute tubular injury in four patients. None of our patients had signs of viral inclusions in kidney cells. One patient died and one remained dialysis‐dependent after the good initial response to treatment. Patients with collapsing and perihilar FSGS had further progression of their chronic allograft nephropathy still without need for dialysis. In conclusion, diverse kidney pathology may be found in SARS‐CoV‐2–infected renal transplant patients. It seems that viral infection may affect the immune system with triggering of glomerular diseases, while the acute tubular injury is of multifactorial etiology. Direct viral effect is less likely.

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“…The primary kidney disease was unknown. Abuzeineh et al [ 44 ] reported a case of a 54-year-old male with a renal transplant from 2015 who presented with AKI and was managed with fluids, oxygen, antibiotics, antifungals and tocilizumab[ 44 ]. Subsequent transplant biopsy revealed AMR which was managed with intravenous immunoglobulin.…”

Section: Resultsmentioning

confidence: 99%

Native and transplant kidney histopathological manifestations in association with COVID-19 infection: A systematic review

Jeyalan¹,

Storrar²,

Wu³

et al. 2021

WJT

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BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can result in clinically significant multi-system disease including involvement in the kidney. The underlying histopathological processes were unknown at the start of the pandemic. As case reports and series have been published describing the underlying renal histopathology from kidney biopsies, we have started to gain an insight into the renal manifestations of this novel disease. AIM To provide an overview of the current literature on the renal histopathological features and mechanistic insights described in association with coronavirus disease 2019 (COVID-19) infection. METHODS A systematic review was performed by conducting a literature search in the following websites-‘PubMed’, ‘Web of Science’, ‘Embase’ and ‘Medline-ProQuest’ with the following search terms-“COVID-19 AND kidney biopsy”, “COVID-19 AND renal biopsy”, “SARS-CoV-2 AND kidney biopsy” and “SARS-CoV-2 AND renal biopsy”. We have included published data up until February 15, 2021, which includes kidney biopsies (native, transplant and postmortem) from patients with COVID-19. Data on clinical presentation, histopathological features, management and outcome was extracted from the reported studies. RESULTS The total number of biopsies reported on here is 288, of which 189 are postmortem, 84 native and 15 transplants. The results are varied and show underlying pathologies ranging from collapsing glomerulopathy and acute tubular injury (ATI) to anti-nuclear cytoplasmic antibody associated vasculitis and pigment nephropathy. There was variation in the specific treatment used for the various renal conditions, which included steroids, hydroxychloroquine, eculizumab, convalescent plasma, rituximab, anakinra, cyclophosphamide and renal replacement therapy, amongst others. The pathological process which occurs in the kidney following COVID-19 infection and leads to the described biopsy findings has been hypothesized in some conditions but not others (for example, sepsis related hypoperfusion for ATI). It is important to note that this represents a very small minority of the total number of cases of COVID-19 related kidney disease, and as such there may be inherent selection bias in the results described. Further work will be required to determine the pathogenetic link, if any, between COVID-19 and the other renal pathologies. CONCLUSION This report has clinical relevance as certain renal pathologies have specific management, with the implication that kidney biopsy in the setting of renal disease and COVID-19 should be an early consideration, dependent upon the clinical presentation.

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Chronic Active Antibody-Mediated Rejection Following COVID-19 Infection in a Kidney Transplant Recipient: A Case Report

Cited by 16 publications

References 17 publications

SARS Cov‐2 vaccination induces de novo donor‐specific HLA antibodies in a renal transplant patient on waiting list: A case report

SARS Cov‐2 vaccination induces de novo donor‐specific HLA antibodies in a renal transplant patient on waiting list: A case report

Histopathologic findings on indication renal allograft biopsies after recovery from acute COVID‐19

Native and transplant kidney histopathological manifestations in association with COVID-19 infection: A systematic review

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