Abstract
Therapeutic management of solid organ transplant (SOT) recipients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19), may challenge healthcare providers given a paucity of clinical data specific to this cohort. Herein, we summarize and review the studies that have formed the framework for current COVID-19 consensus management guidelines. Our review focuses on COVID-19 treatment options including monoclonal antibody products, antiviral agents such as remdesivir, and immunomodulatory agents such as corticosteroids, interleukin inhibitors, and kinase inhibitors. We highlight the presence or absence of clinical data of these therapeutics related to the SOT recipient with COVID-19. We also describe data surrounding COVID-19 vaccination of the SOT recipient. Understanding the extent and limitations of observational and clinical trial data for the prevention and treatment of COVID-19 specific to the SOT population is crucial for optimal management. Although minimal data exist on clinical outcomes among SOT recipients treated with varying COVID-19 therapeutics, reviewing these agents and the studies that have led to their inclusion or exclusion in clinical management of COVID-19 highlights the need for further studies of these therapeutics in SOT patients with COVID-19.
Highlights
Management and prevention of Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can be challenging among solid organ transplant (SOT) recipients
Mortality rates reported among SOT recipients with COVID-19 vary widely from 3% to over 30% depending on organ type, comorbid conditions, geographical location, COVID-19 treatment, and time of report during the pandemic [1,2]
The first company sponsored trial was a randomized controlled trials (RCTs) of patients hospitalized for COVID-19 who were on supplemental oxygen, but not mechanically ventilated, randomized 1:1 to either a 5- or 10-day course of remdesivir [48]
Summary
Management and prevention of Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can be challenging among solid organ transplant (SOT) recipients. Mortality rates reported among SOT recipients with COVID-19 vary widely from 3% to over 30% depending on organ type, comorbid conditions, geographical location, COVID-19 treatment, and time of report during the pandemic [1,2]. SOT recipients often have comorbidities, such as diabetes, chronic kidney disease, and cardiac disease, that have been associated with more severe cases of COVID-19 and an increased risk of mortality. During the COVID-19 pandemic, scientific efforts have advanced therapeutic options and vaccine development. In some cases, these therapeutics have halted the progression of COVID-19 or have improved survival. On room air, and critical illness is defined as respiratory failure, septic shock, or multiple organ dysfunction
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