Editorial: COVID-19 immunology and organ transplantation

Area of Science:

• Pulmonology and Transplant Surgery
• Infectious Diseases and Virology

Background:

• The COVID-19 pandemic critically impacted organ transplantation, particularly lung transplantation, due to the virus's primary respiratory effects.
• Reduced donor availability and a mismatch between waitlist additions and inactivations led to a significant decline in lung transplant procedures during the pandemic's initial phase.

Discussion:

• SARS-CoV-2 infection can trigger severe immune responses, potentially causing post-infectious fibrotic lung disease, complicating care for lung transplant candidates and recipients.
• Outcomes for lung transplant recipients who contract SARS-CoV-2 appear poorer than in the general population, with the role of immunosuppression still under investigation.

Key Insights:

• Lung transplant volumes experienced a notable decrease during the first COVID-19 wave, with a subsequent rebound, but future trends are uncertain due to healthcare limitations.
• Long-term data on lung transplants performed in patients previously infected with SARS-CoV-2 are scarce, leaving outcomes unknown.
• Optimal management strategies for immunosuppression in lung transplant recipients exposed to or infected with SARS-CoV-2 require further research.

Outlook:

• Continued monitoring of lung transplant volumes and patient outcomes is essential to understand the pandemic's lasting effects.
• Further research is needed to address the numerous unanswered questions regarding the management of lung transplant recipients in the context of COVID-19.
• Longitudinal studies are crucial to evaluate the long-term consequences of SARS-CoV-2 infection and transplantation in this vulnerable population.