Antivirals for COVID-19 in Solid Organ Transplant Recipients
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COVID19 AND TRANSPLANTATION (R AVERY, SECTION EDITOR)
Antivirals for COVID-19 in Solid Organ Transplant Recipients Justin C. Laracy 1 & Elizabeth C. Verna 2 & Marcus R. Pereira 1 Accepted: 12 October 2020 # Springer Nature Switzerland AG 2020
Abstract Purpose of Review To evaluate the critical studies published so far on the most promising antiviral therapies for COVID-19, with particular emphasis on any solid organ transplant–specific information. Recent Findings Although the literature is increasing exponentially, most clinical trials have been preliminary, thus lacking robust evidence to support many of the drugs discussed here. The main exception is remdesivir, for which several trials have been published supporting its use for patients with severe COVID-19. No solid organ transplant–specific data on remdesivir or other antiviral therapies have been published so far. Summary While further studies are urgently needed, in particular those specific to solid organ transplant recipients, the evidence so far only supports the use of remdesivir for patients with severe COVID-19. Keywords Remdesivir . Convalescent plasma . COVID-19 . Solid organ transplant . SARS-CoV-2
Introduction The outbreak of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Wuhan, China, in December 2019 evolved into a global pandemic that by July 2020 has led to over 16 million cases and 600,000 deaths worldwide [1]. Though the pathogenesis of coronavirus disease 2019 (COVID-19) remains incompletely understood, the spectrum of clinical manifestations ranges from asymptomatic disease to acute respiratory distress syndrome with septic shock and multiorgan failure [2,3]. Approximately 14% of patients with COVID-19 suffer severe cases and 5% are categorized as critical [4]. The reported mortality rate of patients with COVID-19 has varied significantly, with figures ranging from 2.3 to 7.2% overall and up to 61.5% among critically ill This article is part of the Topical Collection on COVID19 and Transplantation * Marcus R. Pereira [email protected] 1
Department of Medicine, Division of Infectious Disease, Columbia University College of Physicians & Surgeons, 622 W 168th St PH 876 W, New York, NY 10032, USA
2
Department of Medicine, Division of Digestive & Liver Diseases, Columbia University College of Physicians & Surgeons, New York, NY, USA
patients [4–6]. Comorbidities including diabetes mellitus, hypertension, obesity, coronary artery disease, chronic kidney disease, and chronic lung disease are widely recognized as risk factors for severe disease [3]. Solid organ transplant (SOT) recipients are generally at increased risk of viral, bacterial, and fungal infections, and infection remains an important cause of post-SOT mortality. However, whether chronic immunosuppression in SOT with COVID-19 is either protective against or a risk factor for severe COVID-19 is an area of intense investigation, evolving since the initial stages of the outbreak [7]. As such, management of immunosuppression in SOT patients with CO
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