Frontiers in Immunology (Jul 2023)

The Italian data on SARS-CoV-2 infection in transplanted patients support an organ specific immune response in liver recipients

  • Maria Rendina,
  • Michele Barone,
  • Chiara Lillo,
  • Silvia Trapani,
  • Lucia Masiero,
  • Paolo Trerotoli,
  • Francesca Puoti,
  • Luigi Giovanni Lupo,
  • Francesco Tandoi,
  • Salvatore Agnes,
  • Antonio Grieco,
  • Enzo Andorno,
  • Simona Marenco,
  • Edoardo Giovanni Giannini,
  • Umberto Baccarani,
  • Pierluigi Toniutto,
  • Amedeo Carraro,
  • Antonio Colecchia,
  • Matteo Cescon,
  • Maria Cristina Morelli,
  • Umberto Cillo,
  • Patrizia Burra,
  • Paolo Angeli,
  • Michele Colledan,
  • Stefano Fagiuoli,
  • Stefano Fagiuoli,
  • Luciano De Carlis,
  • Luca Belli,
  • Paolo De Simone,
  • Paola Carrai,
  • Fabrizio Di Benedetto,
  • Nicola De Maria,
  • Giuseppe Maria Ettorre,
  • Valerio Giannelli,
  • Salvatore Gruttadauria,
  • Salvatore Gruttadauria,
  • Riccardo Volpes,
  • Sveva Corsale,
  • Vincenzo Mazzaferro,
  • Vincenzo Mazzaferro,
  • Sherrie Bhoori,
  • Renato Romagnoli,
  • Silvia Martini,
  • Giorgio Rossi,
  • Lucio Caccamo,
  • Maria Francesca Donato,
  • Massimo Rossi,
  • Stefano Ginanni Corradini,
  • Marco Spada,
  • Giuseppe Maggiore,
  • Giuseppe Tisone,
  • Ilaria Lenci,
  • Giovanni Vennarecci,
  • Raffaella Tortora,
  • Marco Vivarelli,
  • Gianluca Svegliati Baroni,
  • Fausto Zamboni,
  • Laura Mameli,
  • Silvio Tafuri,
  • Simona Simone,
  • Loreto Gesualdo,
  • Massimo Cardillo,
  • Alfredo Di Leo

DOI
https://doi.org/10.3389/fimmu.2023.1203854
Journal volume & issue
Vol. 14

Abstract

Read online

IntroductionThe study of immune response to SARSCoV-2 infection in different solid organ transplant settings represents an opportunity for clarifying the interplay between SARS-CoV-2 and the immune system. In our nationwide registry study from Italy, we specifically evaluated, during the first wave pandemic, i.e., in non-vaccinated patients, COVID-19 prevalence of infection, mortality, and lethality in liver transplant recipients (LTRs), using non-liver solid transplant recipients (NL-SOTRs) and the Italian general population (GP) as comparators.MethodsCase collection started from February 21 to June 22, 2020, using the data from the National Institute of Health and National Transplant Center, whereas the data analysis was performed on September 30, 2020.To compare the sex- and age-adjusted distribution of infection, mortality, and lethality in LTRs, NL-SOTRs, and Italian GP we applied an indirect standardization method to determine the standardized rate.ResultsAmong the 43,983 Italian SOTRs with a functioning graft, LTRs accounted for 14,168 patients, of whom 89 were SARS-CoV-2 infected. In the 29,815 NL-SOTRs, 361 cases of SARS-CoV-2 infection were observed. The geographical distribution of the disease was highly variable across the different Italian regions. The standardized rate of infection, mortality, and lethality rates in LTRs resulted lower compared to NL-SOTRs [1.02 (95%CI 0.81-1.23) vs. 2.01 (95%CI 1.8-2.2); 1.0 (95%CI 0.5-1.5) vs. 4.5 (95%CI 3.6-5.3); 1.6 (95%CI 0.7-2.4) vs. 2.8 (95%CI 2.2-3.3), respectively] and comparable to the Italian GP.DiscussionAccording to the most recent studies on SOTRs and SARS-CoV-2 infection, our data strongly suggest that, in contrast to what was observed in NL-SOTRs receiving a similar immunosuppressive therapy, LTRs have the same risk of SARS-CoV-2 infection, mortality, and lethality observed in the general population. These results suggest an immune response to SARS-CoV-2 infection in LTRS that is different from NL-SOTRs, probably related to the ability of the grafted liver to induce immunotolerance.

Keywords