SARS-CoV-2 infection dynamics in a MHCI-mismatched lung transplant recipient
Abstract
Abstract A 48-year-old patient underwent lung transplantation because of severe COVID-19, which aggravated his underlying interstitial lung disease, despite the presence of detectable SARS-CoV-2. Subsequently, the graft is re-infected early in the post-procedural phase, leading to viral persistence for more than five months. By analyzing viral evolution and effector immune response within the transplanted organ, we observe three main findings. First, virus evolution differs in the transplanted organ compared to that in the upper respiratory tract and is affected by monoclonal SARS-CoV-2-specific antibodies and molnupiravir. Second, we show the potential clinical relevance of T cell HLA restriction that may facilitate viral clearance in the upper respiratory tract compared to the ongoing viral replication in the HLA mismatch organ. Third, close monitoring and modulation of immunosuppressive and antiviral therapy enables viral clearance in a lung transplantation setting despite incomplete SARS-CoV-2 clearance prior to transplantation.
Article Details
Authors (34)
Jonas Fuchs
Vivien Karl
Ina Hettich
Jaime Alvarado
Daniel Eckert
Lena Jaki
Ann-Kathrin Kohl
Anastasia Kremser
Anastasija Maks
Charlott Terschluse
Prerana Agarwal
Florian Emmerich
Sebastian Fähndrich
Annabelle Flügler
Daniel Hornuss
Johannes Kalbhenn
Nikolaus Kneidinger
Inga Lau
Achim Lother
Isabelle Moneke
David Schibilsky
Elisabeth Schygulla
Nils Venhoff
Gernot Zissel
Martin Czerny
Daniela Huzly
Georg Kochs
Christoph Neumann-Haefelin
Bernward Passlick
Daiana Stolz
Clinic of Respiratory Medicine, Faculty of Medicine, University of Freiburg, Freiburg, Germany
Robert Thimme
Marcus Panning
Maike Hofmann
Björn C. Frye