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We investigated intra\u2010host evolutionary dynamics of SARS\u2010CoV\u20102 under distinct immune pressures exerted by plasma from kidney transplant recipients (KTRs). Wild\u2010type (WT) SARS\u2010CoV\u20102 (B.6.6) and Omicron subvariants (BA.5.2 and XBB.1.5.57) were serially passaged in the presence of convalescent plasma. KTR plasma exerted selective pressure on the spike protein without compromising replicative capacity, thereby facilitating viral diversification and the subsequent fixation of immune escape mutations. Three notable mutations, T95I (B.6.6), A879V (XBB.1.5.57) and I1114F (BA.5.2), were identified under KTR plasma pressure. When engineered into the WT spike, T95I, A879V, and I1114F conferred reductions in neutralization titers (1.5\u2010fold, 6.0\u2010fold, and 2.9\u2010fold, respectively) against plasma from vaccine\u2010boosted individuals. A879V also modestly reduced viral binding and entry in both WT and Omicron backgrounds, suggesting a possible trade\u2010off between immune escape and viral fitness. These findings highlight the potential of antigenically distinct variants to emerge in immunocompromised hosts and the need for enhanced genomic surveillance in this population to preempt variant spread.<\/jats:p>","DOI":"10.1002\/jmv.71016","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T06:55:39Z","timestamp":1781160939000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Immune Pressure From Plasma From Immunocompromised and Healthy Individuals Drives Differential SARS\u2010CoV\u20102 Evolution and Escape Mutation Emergence"],"prefix":"10.1002","volume":"98","author":[{"given":"Jolene Yin Ling","family":"Fu","sequence":"first","affiliation":[{"name":"Department of Medical Microbiology, Faculty of Medicine Universiti Malaya Kuala Lumpur 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