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Kidney Week

Abstract: PO2200

Utility of Noninvasive Rejection Biomarkers to Assess the Risk of Rejection in Kidney Transplant Recipients with Post COVID-19 Infection

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Hoque, Samah, University of Southern California, Los Angeles, California, United States
  • Hsu, Young C., University of Southern California, Los Angeles, California, United States
  • Aramada, Harsha, University of Southern California, Los Angeles, California, United States
  • Ahearn, Aaron J., University of Southern California, Los Angeles, California, United States
  • Maw, Thin Thin, University of Southern California, Los Angeles, California, United States
Introduction

COVID-19 infection is associated with 25% mortality in kidney transplant recipients (KTRs). Treatment of Coronavirus Disease 2019 (COVID-19) infection in KTRs has involved reduction of immunosuppressants (IS). This potentially increases the risk of allograft rejection in the setting of reduced immunosuppression. We reported 6 cases of kidney allograft rejection post COVID infection

Case Description

Total 123 kidney transplant recipients had COVID-19 infection between March 2020 and February 2021. Immunosuppression was reduced routinely in patients who had symptomatic COVID-19 infection. We implemented. We implemented the protocol of screening tests to assess for rejection which included dd-cfDNA, gene expression profile (TruGraf), donor specific antibody (DSA). Elevated serum creatinine greater than 25% over baseline, dd-cfDNA value greater than 1%, TruGraf value of Non-Tx (NT) or up-trending DSA prompted to allograft biopsy to rule out rejection.

Discussion

Twelve patients out of 123 KTRs received kidney biopsy for above mentioned indications Only 4.8% had kidney rejection ( 6 out of 123 patients) : 3 patients with acute cellular rejection (ACR) Banff 1B rejection, 2 patients with borderline ACR, and 1 patient with antibody mediated rejection (AMR). Of these 6 patients with rejection 5 patients have elevated dd-cf DNA peri COVID infection, 3 patients with elevated Cr and 1 patient had Non-Tx. Three patients with rejection were transplanted within 1 years. The patients with Banff 1B rejection were treated with anti- thymocyte globulin (ATG) and 1 patient with AMR due to AT1R antibody was treated with methylprednisolone, IV Ig and Losartan.
Only 4.8% had kidney rejection post COVID infection. Despite reduction in IS, COVID infection did not increase the risk of allograft rejection and can monitor the risk of rejection by using non-invasive rejection biomarkers.