key: cord-0834311-56l78o0q
authors: Caillard, Sophie; Benotmane, Ilies; Gautier Vargas, Gabriela; Perrin, Peggy; Fafi‐Kremer, Samira
title: SARS‐CoV‐2 viral dynamics in immunocompromised patients
date: 2020-10-31
journal: Am J Transplant
DOI: 10.1111/ajt.16353
sha: 64cf9ed815f8bbaba6e3a2bc723b6d79f2b3dfec
doc_id: 834311
cord_uid: 56l78o0q

While the median duration of SARS-CoV-2 viral RNA detection in nasopharyngeal swabs collected from immunocompetent subjects is approximately 18 days,1 data for immunocompromised patients are not yet available. Here, we prospectively monitored the dynamic changes of SARS-CoV-2 RNA viral loads in serial nasopharyngeal swab, saliva, and respiratory specimens collected from kidney transplant recipients (KTR) hospitalized with a confirmed diagnosis of Covid-19.

before. Two cases-in whom the diagnosis was made based on chest CT findings-had persistently negative RT-PCR results throughout the entire study period. Table 1 summarizes the general characteristics of the study patients and their clinical course.

The median viral load at diagnosis was 5.12 (interquartile range: 3.8-6.5) log10 copies per reaction, followed by a gradual decline over the subsequent weeks. The temporal profile of viral loads for each patient is presented in Figure 1A , whereas their general dynamics are summarized in Figure 1B F I G U R E 1 (A) Temporal profile of viral loads in nasopharyngeal swab, saliva, and respiratory specimens obtained from kidney transplant recipients according to the days from the onset of symptoms. Each line represents a patient, whereas one case denotes 1 day (days from the onset of symptoms). The first colored box is the day of the diagnosis. The numbers express viral loads (log10 copies/reaction). To convert viral loads from copies/reaction to copies/mL, add 1.69 log. The gray cases indicate the days either before COVID-19 diagnosis or following patient death. Red cases denote the days until the viral load was measured below 3 log10 copies/reaction, whereas orange cases indicate the days until the viral load became undetectable. Green cases denote days from which viral loads were undetectable until day 60. Patient death; *viral loads measured in tracheal aspiration fluid or BAL; **viral loads measured in saliva (while negative in the nasopharyngeal swab).

(B) General dynamics of viral loads reduction in nasopharyngeal swabs from 42 kidney transplant recipients with COVID-19. Days from the onset of symptoms are plotted along the X axis, whereas viral loads (log10 copies/ reaction) are represented along the Y axis. To convert viral loads from copies/reaction to copies/mL, add 1.69 log. Viral loads were high (3.9 log copies/mL) between 0 and 15 days from the onset of symptoms (plain square), intermediate (1.6 log copies/ reaction) between 15 and 30 days (dashed square), and low (<3 log copies/reaction) between 30 and 60 days (dotted square). Thirty-five percent of specimens were tested positive between day 30 and day 60 and 5 patients had still viral load above 3 log copies/reaction after day 30 (circles). The minimum detection limit of the RT-PCR assay for the identification of SARS-CoV-2 was 10 copies/reaction A B

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