Investigators have found evidence of reduced T cell immunity during COVID-19 illness followed by T cell recovery in kidney transplant recipients. Insufficient immunity appears to occur despite initial reduction of antirejection medications in these patients.

Most centers have empirically reduced anti-rejection immunosuppression in kidney transplant recipients with COVID-19 due to concerns that immunosuppressant use would hinder anti-COVID-19 immunity, Madhav C. Menon, MBBS, of Yale University in New Haven, Connecticut, and colleagues explained in the Journal of the American Society of Nephrology.

The investigators performed transcriptome analyses of blood samples from 31 recipients with acute COVID-19 (less than 4 weeks from diagnosis) and 33 recipients with post-acute COVID-19 (more than 4 weeks after diagnosis). Patients with COVID-19 vaccination were excluded from the study.

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Dr Menon’s team found downregulation of T cell and adaptive immune activation pathways in patients with acute COVID-19 but T cell recovery in patients with post-acute COVID-19. These responses occurred despite reduced immunosuppressant use in a subset of patients during acute COVID-19, and despite reinstitution of immunosuppressants in a subset of patients with post-acute COVID-19.

In line with results from other studies, acute rejection rates were low among kidney transplant recipients. The findings of immune insufficiency during acute COVID-19 may explain the low rates of acute rejection among kidney transplant recipients, according to the investigators.

Different kidney transplant recipients were studied during the acute and post-acute COVID-19 phases, so the investigators could not rule out selection bias. The T-cell signatures among individuals also showed some heterogeneity. Immune insufficiency was worse in patients with severe COVID-19 illness.

The investigators found a similar pattern of T cell downregulation and subsequent recovery using public datasets of patients without a kidney transplant infected with COVID-19.

The study findings were independent of lymphocyte count. As many previous studies have observed, inflammatory cytokines increased with COVID-19 severity.

“These findings have implications for the pathogenesis and management, including [immunosuppression] reduction or antiviral approaches, in COVID-19-infected [kidney transplant recipients],” Dr Menon’s team concluded.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Sun A, Zhang Z, Banu K, et al. Blood transcriptomes of SARS-CoV-2-infected kidney transplant recipients associated with immune insufficiency proportionate to severity. J Am Soc Nephrol. Published online August 30, 2022. doi:10.1681/ASN.2022010125