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Current Pulmonology Reports
Published in: Current Pulmonology Reports 1/2024

Open Access 24-02-2024 | COVID-19 | REVIEW

Management of SARS-CoV-2 and Persistent Viral Detection in Solid Organ Transplant Recipients

Authors: Karen Castro, Chetan A. Naik, Cedric W. Spak, Medhat Askar, Leah Pittmon, Jenifer Williams, Katherine Vandervest, Tiana Endicott-Yazdani, Todd J. Grazia, Robert L. Gottlieb, Susan K. Mathai

Published in: Current Pulmonology Reports | Issue 1/2024

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Abstract

Purpose of Review

We explore the challenges of managing solid organ transplant recipients (SOTRs) during the COVID-19 pandemic, with a focus on prolonged viral detection in immunosuppressed individuals.

Recent Findings

SOTR guidelines recommend three mRNA vaccine doses with additional booster dosing and continued protective post-vaccination measures. COVID-19 therapies are similar for SOTRs and non-SOTRs, although drug-drug interactions limit the use of some such as nirmatrelvir/ritonavir (NIM-RTV). Inpatient treatment options include remdesivir and steroids; outpatient antiviral options include NIM-RTV or remdesivir. Whereas molnupiravir has not been withdrawn in the USA, it is no longer available in Europe due to safety and efficacy concerns, along with selection mutagenesis. Prolonged viral replication in immunosuppressed patients presents the risk of future variant generation and concern for transmission.

Summary

SOTR COVID-19 guidelines emphasize vaccination and protective measures; persistently positive cases remain a challenge. Medications promoting selection mutagenesis are ill-advised for those already at risk of incubating variants capable of immunologic escape.
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Metadata
Title
Management of SARS-CoV-2 and Persistent Viral Detection in Solid Organ Transplant Recipients
Authors
Karen Castro
Chetan A. Naik
Cedric W. Spak
Medhat Askar
Leah Pittmon
Jenifer Williams
Katherine Vandervest
Tiana Endicott-Yazdani
Todd J. Grazia
Robert L. Gottlieb
Susan K. Mathai
Publication date
24-02-2024
Publisher
Springer US
Published in
Current Pulmonology Reports / Issue 1/2024
Electronic ISSN: 2199-2428
DOI
https://doi.org/10.1007/s13665-024-00338-z

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Keynote webinar | Spotlight on medication adherence

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WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
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