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. 2023 Jul 7;15(7):1520.
doi: 10.3390/v15071520.

Impact of B Cell Depletion on COVID-19 in Kidney Transplant Recipients

Naohiro Aida  1 , Taihei Ito  1 , Kei Kurihara  1 , Izumi Hiratsuka  2 , Megumi Shibata  2 , Atsushi Suzuki  2 , Midori Hasegawa  3 , Takashi Kenmochi  1
Affiliations

Impact of B Cell Depletion on COVID-19 in Kidney Transplant Recipients

Naohiro Aida et al. Viruses. .

Abstract

Kidney transplant recipients are patients at high risk for coronavirus disease 2019 (COVID-19) due to being on immunosuppressive therapy. B cell depletion therapy, including rituximab, is an important strategy for ABO-incompatible transplants. However, knowledge about the effect of B cell depletion therapy on COVID-19 is lacking. Thirty kidney transplant recipients who developed COVID-19 were included in this study. To examine the impact of B cell depletion therapy, we retrospectively investigated the relationship between the background of the patients and the clinical outcome. Of the 30 patients, 13 received B cell depletion therapy. The median time between transplant and onset of COVID-19 was 6.1 years after transplantation; however, nine cases remained markedly depleted of CD19(+) cells (<4.0%). The patients were assigned to the normal (n = 21) and depletion groups (n = 9). Progression rates in the depletion and normal groups were 55.6% and 9.5%, respectively (p = 0.014). Furthermore, the survival rate was significantly lower in the depletion group (100% in the normal group vs. 66.7% in the depletion group; p = 0.021). B cell depletion therapy may have long-term effects and increase the risk of COVID-19 in kidney transplant recipients.

Keywords: B-lymphocyte subsets; COVID-19; immunosuppression therapy; kidney transplantation; rituximab.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The clinical course of a patient who died of COVID-19. (a) The clinical course of a patient who died of COVID-19 caused by the Omicron variant. On arrival, the patient was diagnosed with severe disease. Five days of remdesivir and 7 days of high-dose dexamethasone improved respiratory disorder and eliminated oxygen requirement. COVID-19 exacerbated after dose reduction in dexamethasone. Despite intensive therapy including steroid pulse, the patient died on day 34. (b) CT images on arrival. A focal ground-glass opacity is observed in the upper left lobe. (c) CT images on day 10. The ground-glass opacity had spread. It was diagnosed to be a healing process. (d) CT images on day 21. Widespread ground-glass opacities were diagnosed as the progression of COVID-19.
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