The Effects of COVID-19 in Kidney Transplantation: Evidence From Tissue Pathology.

IF 5.3 2区医学 Q1 IMMUNOLOGY Transplantation Pub Date : 2025-02-01 Epub Date: 2025-01-20 DOI:10.1097/TP.0000000000005121

Brian J Nankivell, Chow P'ng, Thomas Tran, Jenny Draper, Danny Ko, Ivan Luu, Kerri Basile, Kathy Kable, Frederika Sciberras, Germaine Wong, Jen Kok

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Abstract

Background: The biological effects of SARS-CoV-2 infection in transplanted kidneys are uncertain with little pathological information.

Methods: This single-center, prospective observational study evaluated kidney transplant biopsies from recipients of deceased donors with COVID-19, current recipients contracting SARS-CoV-2 Omicron variant in 2022, against prior BK virus (BKV) infection and uninfected (without SARS-CoV-2 or BKV) samples, as respective positive and negative comparators (n = 503 samples).

Results: We demonstrated nonvirus tubular injury in implanted tissue from infected donors and prevalent recipients with mild acute COVID-19 and acute kidney injury, excluding direct viral infection as a cause of kidney damage. COVID particles were absent in 4116 ultrastructural images of 295 renal tubules from 4 patients with acute COVID-19. No viral cytopathic effect, viral allograft nephropathy, or SARS-CoV-2 RNA was detected in acute tissues, nor in 128 sequential samples from infected donors or recipients with COVID-19. Following recipient COVID-19 (mean 16.8 ± 12.0 wk post-infection), the biopsy-prevalence of rejection was 33.0% (n = 100 biopsies) versus 13.4% for contemporaneous uninfected controls (n = 337; P < 0.001). Prior COVID-19 was an independent risk factor for incident rejection using multivariable generalized estimating equation adjusted for competing risks (odds ratio, 2.195; 95% confidence interval, 1.189-4.052; P = 0.012). Landmark and matched-pair analyses confirmed an association of SARS-CoV-2 with subsequent transplant rejection, with a similar pattern following BKV infection.

Conclusions: Transplantation from COVID-19+ deceased donors yielded good recipient outcomes without evidence of viral tissue transmission. Acute kidney injury during COVID-19 was mediated by archetypical tubular injury and infection correlated with an increased risk of subsequent rejection.

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COVID-19在肾移植中的作用：组织病理学证据

背景：SARS-CoV-2感染对移植肾脏的生物学影响尚不确定，病理信息也很少：SARS-CoV-2感染对移植肾脏的生物学影响尚不确定，病理信息也很少：这项单中心、前瞻性观察研究评估了COVID-19已故供体受者、2022年感染SARS-CoV-2 Omicron变异型的当前受者的肾移植活检组织，以及作为阳性和阴性对照的先前BK病毒（BKV）感染和未感染（无SARS-CoV-2或BKV）样本（n = 503个样本）：结果：我们在感染供体的植入组织和患有轻度急性 COVID-19 和急性肾损伤的受体中发现了非病毒性肾小管损伤，排除了直接病毒感染导致的肾损伤。在4名急性COVID-19患者的295个肾小管的4116张超微结构图像中没有COVID颗粒。在急性组织中，以及从感染 COVID-19 的供体或受体的 128 份连续样本中，均未检测到病毒细胞病理效应、病毒异位移植肾病或 SARS-CoV-2 RNA。受体感染 COVID-19 后（平均感染后 16.8 ± 12.0 周），活检排斥反应发生率为 33.0%（n = 100 例活检），而同期未感染对照组的排斥反应发生率为 13.4%（n = 337 例；P 结论：受体感染 COVID-19 后，活检排斥反应发生率为 33.0%（n = 100 例活检），而同期未感染对照组的排斥反应发生率为 13.4%（n = 337 例活检）：COVID-19+已故供体的移植结果良好，没有病毒组织传播的证据。COVID-19 期间的急性肾损伤是由典型肾小管损伤和感染介导的，感染与随后发生排斥反应的风险增加有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplantation 医学-免疫学

CiteScore

8.50

自引率

11.30%

发文量

1906

审稿时长

1 months

期刊介绍： The official journal of The Transplantation Society, and the International Liver Transplantation Society, Transplantation is published monthly and is the most cited and influential journal in the field, with more than 25,000 citations per year. Transplantation has been the trusted source for extensive and timely coverage of the most important advances in transplantation for over 50 years. The Editors and Editorial Board are an international group of research and clinical leaders that includes many pioneers of the field, representing a diverse range of areas of expertise. This capable editorial team provides thoughtful and thorough peer review, and delivers rapid, careful and insightful editorial evaluation of all manuscripts submitted to the journal. Transplantation is committed to rapid review and publication. The journal remains competitive with a time to first decision of fewer than 21 days. Transplantation was the first in the field to offer CME credit to its peer reviewers for reviews completed. The journal publishes original research articles in original clinical science and original basic science. Short reports bring attention to research at the forefront of the field. Other areas covered include cell therapy and islet transplantation, immunobiology and genomics, and xenotransplantation.