Almanac of Clinical MedicineAlmanac of Clinical Medicine2072-05052587-9294Moscow Regional Research and Clinical Institute (MONIKI)159810.18786/2072-0505-2021-49-066Research ArticlePotential impact of viral skin diseases and other viral infections on the incidence and severity of COVID-19 in renal transplant patientsPerlinaAnastasia D.<p>Dermatovenereologist, Department of Telemedicine Technologies</p>a_perlina@bk.ruhttps://orcid.org/0000-0002-0629-1270AlexandrovIlya V.<p>MD, PhD, Associate Professor, Deputy Chief Physician for Clinical and Expert Work</p>argenza@mail.ruhttps://orcid.org/0000-0003-2628-1640ProkopenkoElena I.<p>MD, PhD, Senior Research Fellow, Surgical Department of Kidney Transplantation; Professor, Chair of Transplantology, Nephrology and Artificial Organs, Postgraduate Training Faculty</p>renalnephron@gmail.comhttps://orcid.org/0000-0002-7686-9816TerentyevAleksey V.<p>Urologist, Department of Urology</p>terentyevalex1988@gmail.comhttps://orcid.org/0000-0003-4711-9837KulikovPavel A.<p>Urologist, Department of Urology</p>pavelka280795@gmail.comhttps://orcid.org/0000-0002-1388-4242Moscow Regional Research and Clinical Institute (MONIKI)Volgograd Regional Uronephrology Center241220214985095150212202112012022Copyright © 2021, Perlina A.D., Alexandrov I.V., Prokopenko E.I., Terentyev A.V., Kulikov P.A.2021<p><strong>Background</strong><strong>:</strong> COVID-19 in solid organ transplant recipients is usually characterized by more severe disease course and is often associated with life-threatening complications. Identification of additional factors that may affect the risk and severity of the new coronavirus infection could have a significant impact on choosing a management strategy for renal graft recipients.</p>
<p><strong>Aim</strong><strong>:</strong> To evaluate the possibility of cross-immunity between skin manifestations of viral etiology and COVID-19.</p>
<p><strong>Materials</strong> <strong>and</strong> <strong>methods</strong><strong>:</strong> From May 2020 to February 2021 we examined 180 renal graft recipients with a history of transplantation from 2 months to 26.5 years. All patients were categorized into two groups: group I (n=68), those who had confirmed moderate or severe COVID-19 disease and group II (n=112), those without any history of clinical manifestations of the new coronavirus infection (including those with potentially asymptomatic disease). During the study period which lasted for 71 months on average (range, 2 to 318 months), laboratory workup was performed in all patients (on average, twice): dermatological examination and detection of serum antibodies to herpes simplex virus 1, 2, cytomegalovirus, human papilloma virus (HPV), Epstein-Barr virus, SARS-CoV-2.</p>
<p><strong>Results</strong><strong>:</strong> In recipients with HPV-associated skin manifestations, the incidence of COVID-19 was significantly lower than in recipients who did not have them 30.4% (34/112) and 50% (34/68), respectively (p=0.011). The incidence of new coronavirus infection did not differ in the groups of patients with cutaneous manifestations caused by herpes simplex viruses type 1 and 2, and without them. Among recipients with Epstein-Barr virus seropositivity, there were significantly fewer cases of COVID-19 compared to seronegative patients 26.2% (28/107) and 54.8% (40/73), respectively (p=0.0002).</p>
<p><strong>Conclusion</strong><strong>:</strong> HPV-associated dermal manifestations or serum Epstein-Barr virus-seropositivity in renal graft recipients is associated with lower incidence of moderate and severe COVID-19. Further studies are needed to confirm the possibility of cross-immunity against SARS-CoV-2 with other infections.</p>SARS-CoV-2transplantationhuman papillomavirusEpstein-Barr virusSARS-CoV-2трансплантациявирус папилломы человекавирус Эпштейна – Барр[Shingare A, Bahadur MM, Raina S. COVID-19 in recent kidney transplant recipients. Am J Transplant. 2020;20(11):3206–3209. doi: 10.1111/ajt.16120.][Akalin E, Azzi Y, Bartash R, Seethamraju H, Parides M, Hemmige V, Ross M, Forest S, Goldstein YD, Ajaimy M, Liriano-Ward L, Pynadath C, Loarte-Campos P, Nandigam PB, Graham J, Le M, Rocca J, Kinkhabwala M. Covid-19 and Kidney Transplantation. N Engl J Med. 2020;382(25):2475–2477. doi: 10.1056/NEJMc2011117.][Zhang H, Chen Y, Yuan Q, Xia QX, Zeng XP, Peng JT, Liu J, Xiao XY, Jiang GS, Xiao HY, Xie LB, Chen J, Liu JL, Xiao X, Su H, Zhang C, Zhang XP, Yang H, Li H, Wang ZD. Identification of Kidney Transplant Recipients with Coronavirus Disease 2019. Eur Urol. 2020;77(6):742–747. doi: 10.1016/j.eururo.2020.03.030.][Banerjee D, Popoola J, Shah S, Ster IC, Quan V, Phanish M. COVID-19 infection in kidney transplant recipients. Kidney Int. 2020;97(6):1076–1082. doi: 10.1016/j.kint.2020.03.018.][Imam A, Abukhalaf SA, Imam R, Abu-Gazala S, Merhav H, Khalaileh A. Kidney Transplantation in the Times of COVID-19 – A Literature Review. Ann Transplant. 2020;25:e925755. doi: 10.12659/AOT.925755.][Gandolfini I, Delsante M, Fiaccadori E, Zaza G, Manenti L, Degli Antoni A, Peruzzi L, Riella LV, Cravedi P, Maggiore U. COVID-19 in kidney transplant recipients. Am J Transplant. 2020;20(7):1941–1943. doi: 10.1111/ajt.15891.][Castells MC, Phillips EJ. Maintaining Safety with SARS-CoV-2 Vaccines. N Engl J Med. 2021;384(7):643–649. doi: 10.1056/NEJMra2035343.][Agrawal B. Heterologous immunity: Role in natural and vaccine-induced resistance to infections. Front Immunol. 2019;10:2631. doi: 10.3389/fimmu.2019.02631.][Welsh RM, Fujinami RS. Pathogenic epitopes, heterologous immunity and vaccine design. Nat Rev Microbiol. 2007;5(7):555–563. doi: 10.1038/nrmicro1709.][Che JW, Selin LK, Welsh RM. Evaluation of non-reciprocal heterologous immunity between unrelated viruses. Virology. 2015;482:89–97. doi: 10.1016/j.virol.2015.03.002.][Mathurin KS, Martens GW, Kornfeld H, Welsh RM. CD4 T-cell-mediated heterologous immunity between mycobacteria and poxviruses. J Virol. 2009;83(8):3528–3539. doi: 10.1128/JVI.02393-08.][Reche PA. Potential cross-reactive immunity to SARS-CoV-2 from common human pathogens and vaccines. Front Immunol. 2020;11:586984. doi: 10.3389/fimmu.2020.586984.][Russian Society of Dermatovenerologists and Cosmetologists. Federal guidelines on management of verrucae [Internet]. Moscow; 2015. 13 p. Russian. Available from: https://www.ismos.ru/guidelines/doc/virusnye_borodavki.pdf.][Andersson K, Waterboer T, Kirnbauer R, Slupetzky K, Iftner T, de Villiers EM, Forslund O, Pawlita M, Dillner J. Seroreactivity to cutaneous human papillomaviruses among patients with nonmelanoma skin cancer or benign skin lesions. Cancer Epidemiol Biomarkers Prev. 2008;17(1):189–195. doi: 10.1158/1055-9965.EPI-07-0405.]