Infection and rejection: cause-and-effect relationship in kidney transplant recipients

This thesis explores infection and rejection and their bidirectional relationship in kidney transplant recipients (KTRs). Infection-induced immune alterations may trigger rejection and vice versa. COVID-19 and chronic antibody-mediated rejection (cAMR) were the primary infection and rejection subtypes assessed. COVID-19 vaccine efficacy and safety (rejection) concerns impacted vaccine uptake in KTRs. COVID-19 vaccines were less immunogenic in KTRs. However, vaccination significantly reduced the risk of severe infection and death. COVID-19 vaccination and infection were not associated with allograft rejection. Intravenous immunoglobulin therapy for cAMR reduced kidney intragraft immune signatures most significantly relating to B-cells, as well as inflammation and fibrosis.