Impact of COVID-19 in Solid Organ Transplant Recipients

Lara Danziger-Isakov; Emily A. Blumberg; Oriol Manuel; Martina Sester


American Journal of Transplantation. 2021;21(3):925-937. 

In This Article


SARS-CoV-2 and the resulting COVID-19 pandemic have had a profound impact on the world and SOT in particular. Our current understanding has benefitted from the immense productivity and collaboration of scientists and clinicians around the globe, specifically in describing the epidemiology and impact of the virus on transplantation. As data develop regarding the pathogenesis of the virus and its immunologic impact, emerging therapies will require investigation specifically in SOT recipients, a population in the whom the balance between viral control, immune activation, and preservation of graft function requires careful navigation. Global efforts in the development and clinical evaluation of SARS-CoV-2 vaccines have proceeded at an unprecedented pace. Several types of vaccines including attenuated or inactivated whole viruses, protein or peptide vaccines, viral vectors or viral nucleic acids are being explored with promising safety and immunogenicity profiles, and large phase 3 studies are currently being performed worldwide.[170,171] Apart from reluctance toward the use of attenuated whole viruses after transplantation, all vaccine types should hold promise for application in SOT recipients. Nevertheless, data on safety and immunogenicity are currently lacking for SOT, and the potential benefits of a SARS-CoV-2 vaccine in effectively reducing the burden of disease will need to be specifically evaluated in the transplant population. In the meantime, passive immunization with convalescent plasma with high neutralizing titers or with monoclonal antibodies may serve as a temporary intervention, especially early in infection. Challenges remain during the ongoing pandemic not only for transplant infrastructure related to resource availability but also from knowledge gaps in potential donor transmission and candidate optimization.