Attenuated early inflammatory response in solid organ recipients with COVID‐19

Abstract

Immunosuppression leaves transplanted patients at particular risk for severe acute respiratory syndrome 2 (SARS‐CoV‐2) infection. The specific features of coronavirus disease 2019 (COVID‐19) in immunosuppressed patients are largely unknown and therapeutic experience is lacking. Seven transplanted patients (two liver, three kidneys, one double lung, one heart) admitted to the Ludwig‐Maximilians‐University Munich because of COVID‐19 and tested positive for SARS‐CoV‐2 were included. The clinical course and the clinical findings were extracted from the medical record. The two liver transplant patients and the heart transplant patient had an uncomplicated course and were discharged after 14, 18, and 12 days, respectively. Two kidney transplant recipients were intubated within 48 hours. One kidney and the lung transplant recipients were required to intubate after 10 and 15 days, respectively. Immunosuppression was adapted in five patients, but continued in all patients. Compared to non‐transplanted patients at the ICU (n = 19) the inflammatory response was attenuated in transplanted patients, which was proven by decreased IL‐6 blood values. This analysis might provide evidence that continuous immunosuppression is safe and probably beneficial since there was no hyperinflammation evident. Although transplanted patients might be more susceptible to an infection with SARS‐CoV‐2, their clinical course seems to be similar to immunocompetent patients.

COVID-19 in immunocompromised patients: A systematic review of cancer, hematopoietic cell and solid organ transplant patients

“…To be included, the study must have reported clinical data on adult (A-CA) or pediatric (P-CA) cancer patients and SOT or HCT recipients with confirmed COVID-19. Our inclusion and exclusion criteria identified 64 SOT studies, 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 11 HCT studies,…”

SARS-CoV-2 (COVID-19) in patients with some degree of immunosuppression

“…Their adequate clinical course suggests that in patients with this type of transplant the disease has a similar presentation to non-transplanted patients. 59 It should be noted that in a series of seven cases 60 (two liver, three kidney, one lung and one heart) an initial attenuated inflammatory response was evident, suggesting that although patients with transplant immunosuppression may have higher susceptibility to SARS-CoV-2 infection, their clinical course could be similar to that of immunocompetent patients.…”

Transplantation in the era of the Covid‐19 pandemic: How should transplant patients and programs be handled?

“…This makes sense given the reports of seroconversionthat can occur by 2–3 weeks and the duration of viral shedding in the general population of around 12 days 4,27,28 . Similar recommendations can be applied for quarantining infected transplant recipients, who may shed the virus for longer, an average of 3 weeks (2– >6 weeks) 58‐60 . Yet not all agree on transplanting a patientwith a history of SARS‐CoV‐2 infection until this is further verified (4).…”

“…4,27,28 Similar recommendations can be applied for quarantining infected transplant recipients, who may shed the virus for longer, an average of 3 weeks (2->6 weeks). [58][59][60] Yet not all agree on trans-…”

“…14,59,72,73 Indeed it was demonstrated that early inflammation and Il-6 levels are mitigated in transplant recipients which may impart favourable outcomes. 60 Centers should probably avoid pre-emptive changes to their protocols and should rather resume their evidence-based protocols for induction, maintenance, and rejection therapy based on patients' global profiles until more evidence justifies manipulations that could have potential serious consequences on graft and patient survival. 57,60 Manipulation of immunosuppressive drugs is a very delicate issue.…”