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Glueck, O.M.* ; Liang, X.* ; Badell, I.* ; Wratil, P.R.* ; Graf, A.* ; Krebs, S.* ; Blum, H.* ; Hellmuth, J.C.* ; Scherer, C.* ; Hollaus, A. ; Spaeth, P.M.* ; Karakoc, B.* ; Fuchs, T.* ; Zimmermann, J.* ; Kauke, T.* ; Moosmann, A. ; Keppler, O.T.* ; Schneider, C.* ; Muenchhoff, M.*

Impaired immune responses and prolonged viral replication in lung allograft recipients infected with SARS-CoV-2 in the early phase after transplantation.

Infection, DOI: 10.1007/s15010-023-02116-6 (2023)
Publ. Version/Full Text DOI PMC
Open Access Gold (Paid Option)
Creative Commons Lizenzvertrag
PURPOSE: Lung transplant recipients are at increased risk of severe disease following infection with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) due to high-dose immunosuppressive drugs and the lung is the main organ affected by Coronavirus disease 2019 (COVID-19). Several studies have confirmed increased SARS-CoV-2-related mortality and morbidity in patients living with lung allografts; however, detailed immunological studies of patients with SARS-CoV-2 infection in the early phase following transplantation remain scarce. METHODS: We investigated patients who were infected with SARS-CoV-2 in the early phase (18-103 days) after receiving double-lung allografts (n = 4, LuTx) in comparison to immunocompetent patients who had not received solid organ transplants (n = 88, noTx). We analyzed SARS-CoV-2-specific antibody responses against the SARS-CoV-2 spike and nucleocapsid proteins using enzyme-linked immunosorbent assays (ELISA), chemiluminescence immunoassays (CLIA), and immunoblot assays. T cell responses were investigated using Elispot assays. RESULTS: One LuTx patient suffered from persistent infection with fatal outcome 122 days post-infection despite multiple interventions including remdesivir, convalescent plasma, and the monoclonal antibody bamlanivimab. Two patients experienced clinically mild disease with prolonged viral shedding (47 and 79 days), and one patient remained asymptomatic. Antibody and T cell responses were significantly reduced or undetectable in all LuTx patients compared to noTx patients. CONCLUSION: Patients in the early phase following lung allograft transplantation are vulnerable to infection with SARS-CoV-2 due to impaired immune responses. This patient population should be vaccinated before LuTx, protected from infection post-LuTx, and in case of infection treated generously with currently available interventions.
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Publication type Article: Journal article
Document type Scientific Article
Corresponding Author
Keywords Covid-19 ; Immune Responses ; Immunosuppression ; Lung Transplant Recipients ; Solid Organ Transplantation
ISSN (print) / ISBN 0300-8126
e-ISSN 1439-0973
Journal Infection - A Journal of Infectious Disease
Publisher Urban & Vogel
Non-patent literature Publications
Reviewing status Peer reviewed
Institute(s) Research Unit Gene Vector (AGV)