Reinfection with SARS‐CoV‐2 in solid‐organ transplant recipients: Incidence density and convalescent immunity prior to reinfection

Abstract

Background Long‐term protective immunity to severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) remains poorly characterized, particularly in solid organ transplant (SOT) patients. Method We determined the incidence density of SARS‐CoV‐2 reinfection in a cohort of adult SOT recipients initially infected between March 1st, 2020 and March 30th, 2021 and included those with initial infection before or after transplantation. Incidence density was the total cases divided by total days after initial diagnosis with active graft. Results Of 210 infected recipients, five (2.4%) developed reinfection, including two who had received full mRNA vaccination, but none developed hypoxia. The incidence density for reinfection was 9.4 (95% confidence interval [CI] 3.9‐22.6) and for primary infection the density was 9.1 (95% CI 7.9–10.5) cases/100,000 patient days. Two recipients had immunity evaluated in the weeks prior to reinfection, by measuring immunoglobulin‐G (IgG) antibody titer to the SARS‐CoV‐2 receptor binding domain and virus‐specific CD4+ and CD8+ T‐cell reactivity following stimulation with SARS‐CoV‐2 peptide pools. Both mounted virus specific CD4 T‐cell responses prior to reinfection (1.19% and 0.28% of total CD4 T cells) and both had reactive IgG testing (1.30 and 4.99 signal/cut off ratio). Conclusions This suggests that SOT recipients infected with SARS‐CoV‐2 remain at high risk for reinfection even after generating cellular and humoral immune responses.

Risk of reinfection and disease after SARS‐CoV‐2 primary infection: Meta‐analysis

“…Of the 3282 papers initially retrieved, we included 91 cohort studies evaluating the onset of reinfection, severe and very severe/lethal COVID‐19 among 15,034,624 previously infected subjects (Figure 1), either among health care workers (27 publications; n = 37,598 2,8,9,15,17,24,36,38,42–59 ) or in the general population (67 publications; n = 14,997,026 3–7,10,12,16–23,25–27,43,49,60–106 ).…”

“…As shown in Table S1, most of the included studies ( n = 43) were carried out in Europe, 2,4–10,12,15,17,18,21,24,26,36,38,44,46–51,58,66,69,71,72,75,81,85–88,91–93,95,99,102 24 in the USA, 20,22,23,25,42,43,57,59,63,67,77,79,82–84,89,90,97,98,103,105–107 18 in Asia 3,16,19,27,45,52–54,56,60,62,64,65,70,73,74,100,101 and the remaining six in South America or South Africa 61,68,80,94,96,104 . The mean age of the participants ranged from 15 to 87 years, and the average follow‐up ranged from 29 to 371 days.…”

Comment on “Re‐infection with SARS‐CoV‐2 in solid‐organ transplant recipients”

“…found that SOT patients infected with SARS‐CoV‐2 are at high risk for re‐infection. 1 We agree that in the case of SOT, the immunological response to COVID‐19 may differ from that of healthy people. The current research can show that re‐infection is a possibility.…”

“…We would like to share ideas on the publication “Re‐infection with SARS‐CoV‐2 in solid‐organ transplant (SOT) recipients: Incidence density and convalescent immunity prior to re‐infection. 1 ” Even after establishing cellular and humoral immune responses, Morris et al. found that SOT patients infected with SARS‐CoV‐2 are at high risk for re‐infection.…”

Response to Letters regarding “Re‐infection with SARS‐CoV‐2 in solid‐organ transplant (SOT) recipients: Incidence density and convalescent immunity prior to re‐infection”

“…We would like to reply to the letter from Sookaromdee and Wiwanitkit 1 concerning our publication “Re‐infection with SARS‐CoV‐2 in solid‐organ transplant (SOT) recipients: Incidence density and convalescent immunity prior to re‐infection.” 2 …”