Distinct immune memory induced by SARS-CoV-2 in convalescent liver transplant recipients

The understanding of how the host immune response differs in T-cell phenotype and memory formation during SARS-CoV-2 infection in liver transplant recipients (LTRs) remains limited. LTRs who recovered from COVID-19 infection without prior vaccination represent a unique population for studying immune responses to SARS-CoV-2. Six LTRs with positive neutralizing antibodies (nAb+) and six LTRs with negative nAb (nAb-) were included at 6 months following COVID-19 infection. It was found that nAb+ LTRs had higher anti-RBD IgG titers and greater neutralizing percent inhibition compared to nAb- LTRs. Fifteen T-cell subsets were identified in COVID-19 convalescent LTRs, and it was shown that only terminal effector CD8+ - 3 decreased in the nAb+ group, while elevated IL-10 expression levels were found in the nAb- group. After stimulation with the SARS-CoV-2 XBB spike peptide pool <i>in vitro</i>, it was observed that the nAb+ group exhibited an increase in effector memory CD4+ cells with lower PD-1 expression, a reduction in effector memory CD4+ - 2 cells, and terminal effector CD8+ - 3 cells, while the nAb- group showed high expression of CTLA-4 and IL-10 in terminal effector CD8+ - 3 cells. Four SARS-CoV-2-specific T-cell subsets were identified, with high expression of TNF-α and IFN-γ in terminal effector CD8+ - 1 and terminal effector CD8+ - 2 cells in both groups. Perforin was mainly detected in terminal effector CD8+ - 2 cells in nAb+ LTRs. In addition to these proportional differences, stem cell memory CD4+ cells with higher IL-17A expression and stem cell memory CD8+ cells with higher CTLA-4 expression were also found in nAb- LTRs. These findings suggest that LTRs who developed nAb+ following SARS-CoV-2 infection exhibit stronger T-cell responses, with more robust immune activation and memory recall, compared to nAb- LTRs. This study underscores the importance of understanding T-cell responses during SARS-CoV-2 recovery for guiding vaccination strategies and managing immunity in LTRs.