The solid organ transplant recipient with SARS-CoV-2 infection

Abstract

Purpose of review The COVID-19 pandemic is a major challenge to global health, particularly among vulnerable populations. Here, we describe the emerging epidemiology and relevant data on treatment options for COVID-19. We discuss the implications of current knowledge for solid organ transplant (SOT) recipients. Recent findings Risk factors and outcomes of COVID-19 among SOT recipients remain uncertain, but recent data suggest similar outcomes to the general population. Case reports of donor-derived SARS-CoV-2 infection are emerging. Few studies on treatment of COVID-19 among SOT recipients are available, and therefore, general recommendations are similar to the general population. Vaccine efficacy in the SOT population is uncertain. Summary COVID-19 remains a significant threat to SOT recipients and studies on treatment and prevention specific to this population are urgently needed. Although vaccines represent the greatest hope to control this pandemic, their efficacy in this immunocompromised population is uncertain.

The Immunology of SARS-CoV-2 Infection and Vaccines in Solid Organ Transplant Recipients

“…After initial reports of success, however, most of them failed to improve patient outcomes in randomized controlled trials. To date, there have been no randomized studies among SOT recipients [74]. Reports of specific medications that were used in SOT recipients are described below.…”

“…Severe illness (i.e., mechanical ventilation or extra corporeal membrane oxygenation-ECMO requirement): dexamethasone (or equivalent steroid) up to 10 days, consider remdesivir for 5 days, and consider reducing or holding antimetabolite [74].…”

Solid organ transplantations and COVID-19 disease

“…Angiotensin-converting enzyme-2 and dipeptidyl peptidase, expressed in proximal tubular cells, are identified as receptors for SARS-CoV and MERS-CoV[ 12 ]. The possible explanation for acute renal injury is the uptake of SARS-CoV-2 virus into the proximal tubular epithelium and virus infection inducing CD68+ -macrophage infiltration and enhancing complement C5b-C9 deposition on tubules[ 13 ].…”

“…Several studies have reported that immunosuppression may be a possible risk factor for coronavirus-related pneumonia in a patient[ 13 ]. For kidney transplant recipients diagnosed with SARS-CoV-2, it may be reasonable to use cyclosporine because of its antiviral and immune modulatory effects[ 13 ].…”

“…Several studies have reported that immunosuppression may be a possible risk factor for coronavirus-related pneumonia in a patient[ 13 ]. For kidney transplant recipients diagnosed with SARS-CoV-2, it may be reasonable to use cyclosporine because of its antiviral and immune modulatory effects[ 13 ]. According to various clinical studies, severe pneumonia has been more widely reported in patients receiving anti-rejection and induction therapies, possibly due to immunosuppression[ 15 ].…”