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BACKGROUND When patients with chronic kidney disease are infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) they can face two specific problems: Virus-specific immune responses may be impaired and remdesivir, an antiviral drug described to shorten recovery, is contraindicated. Antiviral treatment with convalescent plasma could be an alternative treatment option. METHODS In this case report we present two kidney transplant recipients and two haemodialysis patients who were infected with SARS-CoV-2 and received convalescent plasma. Antibodies against the receptor-binding domain in the S1 subunit of the SARS-CoV-2 spike protein were determined sequentially by IgG ELISA and neutralization assay and specific cellular responses by interferon-gamma ELISpot. RESULTS Prior to treatment, in both kidney transplant recipients and one haemodialysis patient antibodies were undetectable by ELISA (ratio < 1.1), corresponding to low neutralizing antibody titers (≤ 1:40). ELISpot responses in the four patients were either weak or absent. After convalescent plasma treatment, we observed an increase of SARS-CoV-2-specific antibodies (IgG ratio and neutralization titer) and of specific cellular responses. After intermittent clinical improvement, one kidney transplant recipient again developed typical symptoms at day 12 after treatment and received a second cycle of convalescent plasma treatment. Altogether, three patients clinically improved and could be discharged from hospital. However, one 83 year-old multimorbid patient deceased. CONCLUSION Our data suggest that the success of convalescent plasma therapy may only be temporary in patients with chronic kidney disease; which requires close monitoring of viral load and antiviral immunity and possibly an adaptation of the treatment regimen. This article is protected by copyright. All rights reserved.
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Journal_of_medical_virology
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SARS-CoV-2-specific humoral and cellular immunity in two renal transplant and two haemodialysis patients treated with convalescent plasma.
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