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<p>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.</p>

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SARS-CoV-2 infection dynamics in a MHCI-mismatched lung transplant recipient

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月16日

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  • 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,
  • Robert Thimme,
  • Marcus Panning,
  • Maike Hofmann,
  • Björn C. Frye

摘要

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.