key: cord-1022538-pwgsl32m
authors: Aigner, Clemens; Dittmer, Ulf; Kamler, Markus; Collaud, Stephane; Taube, Christian
title: COVID-19 in a lung transplant Recipient
date: 2020-04-13
journal: J Heart Lung Transplant
DOI: 10.1016/j.healun.2020.04.004
sha: 894b681d83d0ac8d2ef6596ed0710f6fd2521251
doc_id: 1022538
cord_uid: pwgsl32m

nan

in FEV1 to 1.28l (57% predicted). Upon questioning she expressed mild exercise dyspnea and a dry cough but no fever or diarrhea. The patient had no concerning travel history. Immunosuppression consisted of tacrolimus 0.6 mg twice daily (trough level was 5-7 ng/dl due to alemtuzumab induction and history of osteomyelitis), and 5mg prednisolone daily. Leucocyte count was 11.36 thousand/microliter (6% lymphocytes), CRP 1.0 milligramm/deciliter, LDH 297 units/liter, CK32 units/liter. There was no thrombocytopenia. Arterial oxygen was a PaO2 of 55mmHg without The patient was discharged home on day 21.

In a report based on data collected in China from 1099 patients during the two first months of Covid-19 outbreaks, 5% of the patients were admitted to ICU, 2.3% underwent invasive mechanical ventilation and 1.4% died (2) . While older patients (above 50 years old) and patients presenting coexisting disorders are more prone to suffer from severe disease, data on disease presentation and evolution in immunocompromised patient is scarce. In the first report of Covid-19 outbreak, two patients (0.2%) with Covid-19 and a not otherwise specified "immunodeficiency" were reported.

Both patients had non-severe disease and none was admitted to the ICU, underwent invasive mechanical ventilation or died. In a 52-year old patient who had kidney transplantation 12 years earlier and a confirmed Covid-19, successful recovery was achieved following reduction of immunosuppressant therapy coupled with low dose methylprednisolone-based therapy (3). In two heart transplant recipients, both recovered after supportive therapy with antibiotics and antiviral therapy coupled to reduction of immunosuppressive therapy (4) . From these first very early experiences with Covid-19 in renal, heart and lung transplant recipients, disease presentation seemed to be similar as in the general population. Whether Covid-19 is more severe or probably mitigated due to the effects of the immunosuppression on virus replication in patient after solid organ transplantation is still unknown but recovery was so far possible in most reported cases, although some anecdotal unpublished reports from Italy suggest a higher morbidity in older transplant recipients. Based on this experience a higher clinical suspicion is warranted and early testing is recommended, since COVID-19 can be present even in relatively asymptomatic patients after lung transplantation. Chest Computerized Tomography scan at admission with ground glass opacity and dystelectatic areas in the left lung 

Replication of human coronaviruses SARS-CoV, HCoV-NL63 and HCoV-229E is inhibited by the drug FK506

Zhong NS; China Medical Treatment Expert Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China

Successful recovery of COVID-19 pneumonia in a renal transplant recipient with long-term immunosuppression

First cases of COVID-19 in Heart Transplantation from China