Covid 19 in a lung transplant population

COVID 19 (SARS-COV-2) disease expression remains uncertain. Immunocompromised individuals may be at particular risk of increased mortality. Lung transplant recipients provide a unique phenotype because the allograft is a preferred host location for the SARS-COV-2.We conducted a single centre review of all lung transplant recipients SARS-COV-2 PCR positive between 17th March and June 2020. 7 of a total of 266 lung transplant recipients were SARS-COV-2 positive. 4 cases had a descriptive analysis of the immune microenvironment.There was no association between COVID 19 disease severity and time from transplant. The most prevalent comorbidities were chronic kidney disease (86%), hypertension (71%) and diabetes mellitus (42%). One case died and 6 recovered. Forty-two percent of cases had established chronic allograft dysfunction. Six patients were receiving Azithromycin 500mg, 3 times per week prior COVID 19. Immunosuppression was altered in the three severe cases with calcineurin inhibitor (CNI) reduction and antimetabolite withdrawal.The frequency of both CD4 and CD8 T cell subtypes were low in all 4 patients analysed. In the 2 severe cases CD8 subpopulations responsible for cellular antiviral response were profoundly diminished. The recipient requiring mechanical ventilation demonstrated an increased CD4/CD8 ratio of 5.9 and significantly reduced NK cells. NK cell reduction corresponded with disease severity.The indirect potential COVID 19 prophylaxis with Azithromycin may have...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Transplantation Source Type: research

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