Solid organ transplantations and COVID-19 disease

Abstract

Tens of thousands of people worldwide became infected with severe acute respiratory syndrome coronavirus-2. Death rate in the general population is about 1%-6%, but this rate rises up to 15% in those with comorbidities. Recent publications showed that the clinical progression of this disease in organ recipients is more destructive, with a fatality rate of up to 14%-25%. We aimed to review the effect of the pandemic on various transplantation patients. Coronavirus disease 2019 (COVID-19) has not only interrupted the lives of waiting list patients’; it has also impacted transplantation strategies, transplant surgeries and broken donation chains. COVID-19 was directly and indirectly accountable for a 73% surplus in mortality of this population as compared to wait listed patients in earlier years. The impact of chronic immunosuppression on outcomes of COVID-19 remains unclear but understanding the immunological mechanisms related to the virus is critically important for the lifetime of transplantation and immune suppressed patients. It is hard to endorse changing anti-rejection therapy, as the existing data evaluation is not adequate to advise substituting tacrolimus with cyclosporine during severe COVID-19 disease.

Keywords: COVID-19; SARS-CoV-2; Solid organ transplantation; Mortality; Immunosuppression; Comorbidity

Core Tip: Coronavirus disease 2019 (COVID-19) has not only interrupted the lives of waiting list patients’; it has additionally impacted transplantation policies, transplant surgeries and broken donation chains. Revised guidelines should advise to continue cyclosporine use as an immunosuppressant to the patients during COVID-19 disease excluding some of patients having kidney failure, severe leucopenia or high serum cyclosporine levels.