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Immunological parameters associated with the severity of COVID-19 pneumonia in kidney transplant recipients

  • Ozkok, Abdullah1
  • Alpay, Nadir2
  • Alan, Servet1
  • Bakan, Nur Dilek1, 3
  • Soysal, Fusun1
  • Yazici, Halil1, 4
  • Ekşioğlu-Demiralp, Emel1
  • Yildiz, Alaattin1, 4
  • 1 Memorial Şişli Hospital,
  • 2 Department of Nephrology and Kidney Transplantation, Memorial Hizmet Hospital, Istanbul, Turkey
  • 3 Uskudar University,
  • 4 Istanbul University,
Published Article
International Urology and Nephrology
Publication Date
Aug 20, 2021
DOI: 10.1007/s11255-021-02947-y
PMID: 34415473
PMCID: PMC8377705
PubMed Central
  • Nephrology - Original Paper


Purpose An outbreak of a novel respiratory disease due to coronavirus species was emerged in 2019 and named as Coronavirus Disease-2019 (COVID-19). Clinical and immunological factors affecting the course of COVID-19 in kidney transplant recipients (KTR) are not well-known. Methods In this prospective observational study, we presented 20 KTR with COVID-19 pnemonia and examined the factors predicting the severity of COVID-19. A total of 10 KTR without COVID-19 was used as control group. Lymphocyte subsets were determined by flow cytometry. In 13/20 patients, immunophenotyping was repeated 1 week later. Results Mean age of the patients was 50 ± 9 years. Patients were classified as mild–moderate (oxygen saturation: SO2 > 90%) and severe disease groups (SO2 ≤ 90%). Serum albumin and hemoglobin were lower and CRP, fibrinogen and peak d -dimer were higher in severe group. Peak CRP was inversely associated with nadir SO2 ( r = − 0.68, p = 0.001). Neutrophil/lymphocyte ratio was higher in severe group ( p = 0.01). CD3 + and CD4 + cells were lower and NK cell percentage (CD16 + 56 +) was higher in severe group. Percentage of spontaneously activated CD8 cells (CD8 + CD69 +) was higher in severe group. In comparison of KTR with and without COVID-19, CD8 + cells were lower but NK cell percentage was higher in KTR with COVID-19. Conclusion In this pilot study, increased NK cells, activated CD8 + cells and decreased CD3 + and CD4 + cells were associated with severity of COVID-19 in KTR. Peripheral immunophenotyping of lymphocyte subtypes may provide prognostic information about the clinical course of COVID-19 in KTR. Supplementary Information The online version contains supplementary material available at 10.1007/s11255-021-02947-y.

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