Transplantation July 2021 Issue

JUST RELEASED - TRANSPLANTATION - JULY ISSUE

In this issue the unfolding story of COVID in transplant recipients is further exposed. HIV, CMV and phage therapy add to the focus on viruses. A series of technologies applied to questions in transplantation show their value: from 18-FDG-PET scanning, to deep sequencing T cell receptors and high throughput metabolomics. Long term outcomes from sequential bone marrow and kidney transplants are reported as are combined liver and kidney transplants. Antibodies continue to figure large in research as described in several papers including a masterful overview of non-HLA antibodies.

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SAVE THE DATE for TTS 2022

SAVE THE DATE
for the leading global congress in transplantation!

Join us in Buenos Aires, Argentina,
10-14 September 2022,
for the 29th International Congress of The Transplantation Society (TTS 2022)


Transplantation - Editor-in-Chief Highlighted Article

Dr. Jeremy R. Chapman
Editor-in-Chief, Transplantation

SARS-CoV-2 Vaccination, Immune Responses, and Antibody Testing in Immunosuppressed Populations: Tip of the Iceberg

Woodle, E. Steve; Gebel, Howard M.; Montgomery, Robert A.; Maltzman, Jonathan S.
Transplantation: June 17, 2021 - Volume Online First - Issue -
doi: 10.1097/TP.0000000000003859

Transplantation is keeping the community updated on data about COVID and transplant patients. The latest papers are available online including a recent commentary on the problem of Vaccination by Woodle et al.

What we know so far:
Two mRNA vaccine shots deliver an antibody response in about 40-50% of patients but is quite weak in some of those people. A third shot may help boost that response rate a bit. Taking Belatacept prevents a response, as one might expect, standard therapy with Mycophenolate and Tacrolimus reduces responses. We also know that breakthrough infections occur and can result in very severe disease in our patients and even death.

Please read the details in Transplantation so you can keep up to date in the advice you give your patients.

TTS Masterclasses: Immunosuppression Series July 5 & 7

Delivered by the world’s best known and regional experts, each Masterclass includes presentations by an international and a regional expert to bring perspective to the topic, highlight differences and opportunities, and bolster active discussions.

Hot Off The Press 

«HOT OFF THE PRESS» 
RECENT PUBLICATIONS IDENTIFIED
BY TTS EDUCATION COMMITTEE ON COVID-19

Selected Publications by TTS Education Committee. This week's selection made by Drs. Enver Akalin, Millie Samaniego, and Marlies Reinders

Three Doses of an mRNA Covid-19 Vaccine in Solid-Organ Transplant Recipients

Nassim Kamar et al.
New England Journal of Medicine June 23, 2021. DOI: 10.1056/NEJMc2108861 PMID: 34161700
Three doses of the messenger RNA vaccine BNT162b2 (Pfizer–BioNTech) was given to 101 solid organ transplant recipients. The group included 78 kidney-transplant recipients, 12 liver-transplant recipients, 8 lung-transplant or heart-transplant recipients, and 3 pancreas-transplant recipients. The first two doses were given 1 month apart, and the third dose was administered 61±1 days after the second dose. The prevalence of anti–SARS-CoV-2 antibodies was 0% (95% confidence interval [CI], 0 to 4; 0 of 101 patients) before the first dose, 4% (95% CI, 1 to 10; 4 of 101 patients) before the second dose, 40% (95% CI, 31 to 51; 40 of 99 patients) before the third dose, and 68% (95% CI, 58 to 77; 67 of 99 patients) 4 weeks after the third dose. Patients who did not have an antibody response were older, had a higher degree of immunosuppression, and had a lower estimated glomerular filtration rate than patients who had an antibody response. This study showed that administration of a third dose of the BNT162b2 vaccine to solid-organ transplant recipients significantly improved the immunogenicity of the vaccine, with no cases of Covid-19 reported in any of the patients. However, a large proportion of the patients remain at risk for Covid-19. Barrier measures should be maintained, and vaccination of the relatives of these patients should be encouraged.

SARS-CoV-2 mRNA vaccines induce persistent human germinal centre responses

Jackson Turner et al.
Nature June 28, 2021. https://www.nature.com/articles/s41586-021-03738-2
This study examined antigen-specific B cell responses in peripheral blood (n=41) and draining lymph nodes (LNs) in 14 individuals who received two doses of BNT162b2. By examining fine needle aspirates (FNAs) of draining axillary LNs, the study identified germinal center (GC) B cells that bound S protein in all participants sampled after primary immunization. Remarkably, high frequencies of S-binding GC B cells and PBs were sustained in these draining LNs for at least twelve weeks after the booster immunization. S-binding GC B cell-derived monoclonal antibodies predominantly targeted the receptor binding domain of the S protein, with fewer clones binding to the N-terminal domain or to epitopes shared with the S proteins of the human betacoronaviruses OC43 and HKU1. The latter cross-reactive B cell clones had higher levels of somatic hypermutation compared to those that only recognized SARS-CoV-2 S protein, suggesting a memory B cell origin. This study demonstrates that SARS-CoV-2 mRNA-based vaccination of humans induces a persistent GC B cell response, enabling the generation of robust humoral immunity.

Impaired humoral immunity to SARS-CoV-2 BNT162b2 vaccine in kidney transplant recipients and dialysis patients

Hector Rincon-Arevalo et al.
Science Immunology 15 Jun 2021. : Vol. 6, Issue 60, eabj1031 DOI: 10.1126/sciimmunol.abj1031
This study analyzed humoral and B cell responses of 35 healthy control (HC), 44 dialysis patients (DP) and 40 kidney transplant recipients (KTR). Markedly impaired anti-BNT162b2 responses were identified among KTR and DP compared to HC. In DP, the response was delayed (3-4 weeks after boost) and reduced with anti-S1 IgG and IgA positivity in 70.5% and 68.2%, respectively. In contrast, KTR did not develop IgG responses except one patient who had a prior unrecognized infection and developed anti-S1 IgG. The majority of antigen-specific B cells (RBD+) were identified in the plasmablast or post-switch memory B cell compartments in HC, whereas RBD+ B cells were enriched among pre-switch and naïve B cells from DP and KTR. These data indicated that immunosuppression resulted in impaired protective immunity after mRNA vaccination, including Ig induction with corresponding generation of plasmablasts and memory B cells.

Session 1 - In Your Local Time: Local time
Session 2 - In Your Local Time: Local time

Overview

TTS and WIT are hosting two networking discussion sessions lead by TTS Education Committee Members and WIT Members. Clips from the documentary will be shown and discussed as well as key themes that came out of the movie.

Registrants will have the ability to ask questions and interact with each other. Whether you will be joining for your morning coffee or pre/post dinner drinks, the session will be lively and interactive. Even if you are unable to watch the movie prior to the session, you are encouraged to register and join.

How to watch the documentary first

Registrants will have the ability to watch the documentary "Picture a Scientist" for two weeks prior to the discussion session and 1 week following the discussion session. The link will be provided after signup.
Women in Transplantation is delighted to announce two symposia as part of the 2021 CAST Virtual Congress, July 25-28.
Access to the Women in Transplantation symposia is FREE to WIT members.

Dr. Germaine Wong
Dr. Vathsala Anantharam
Symposium 1 (click for details)
Symposium 1 - In Your Local Time: Local time
  • Dr. Vathsala Anantharam - Equity in donors and recipients in places with disparities
  • Dr. Germaine Wong - Equity in leadership
  • Dr. Maggie Ma - Fertility and pregnancy post solid organ transplantation
  • Dr. Lkhaakhuu Od-Erdene - How women can bring change to organ transplantation – the Mongolian experience

Dr. LKhaakhuu
Od-Erdene
Dr. Vasanthi Ramesh
Symposium 2 (click for details)
Symposium 2 - In Your Local Time: Local time
  • Dr. Allison Tong, Dr. Nicole Scholes-Robertson and Dr. Amanda Dominello - Gender balance in living donation – from the recipient and donor perspective
  • Dr. Vasanthi Ramesh - Sex disparities in access to transplantation care during COVID-19 in Asia
  • Dr. Deirdre Sawinski - Fertility and pregnancy post solid organ transplantation
  • This session will be followed by a 30 minute panel discussion.

Upcoming and Recent Webinars 

Thursday, July 22, 2021 - 10:00 AM (Local time in Montreal)
Local time (Corresponding local time at your current location)

TTS-IRTA Webinar Recording now available!

Live session date : Wednesday June 23, 2021

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