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World J Transplant. Sep 18, 2020; 10(9): 267-276
Published online Sep 18, 2020. doi: 10.5500/wjt.v10.i9.267
Post-transplant immunosuppression and COVID-19: From a double whammy to a mixed blessing
Ashwin Rammohan
Ashwin Rammohan, The Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai 600044, India
Author contributions: Rammohan A contributed to conception and design, acquisition, analysis and interpretation of data, drafted the article, revised it critically for important intellectual content and gave the final approval of the version to be published.
Conflict-of-interest statement: The above doctor has no conflicts of interest or financial ties to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ashwin Rammohan, FACS, FRCS, Attending Doctor, Surgeon, The Institute of Liver Disease and Transplantation, Dr.Rela Institute and Medical Centre, CLC Works Road, Chennai 600044, India. ashwinrammohan@gmail.com
Received: May 19, 2020
Peer-review started: May 19, 2020
First decision: June 3, 2020
Revised: July 21, 2020
Accepted: August 15, 2020
Article in press: August 15, 2020
Published online: September 18, 2020
Processing time: 119 Days and 19.9 Hours
Abstract

The coronavirus pandemic (COVID-19) has had an unprecedented effect on various disease processes and their management. COVID-19 is likely to have a complex pathophysiological interplay with the post-transplant patients; one affecting the clinical course and outcome of the other. In the absence of validated data from trials, there is strong dependence on experience based on previous similar epidemics (SARS/MERS), and from consensus based on expert opinions. Despite the fact that our knowledge is rapidly evolving with time, there still is relatively limited objective data on the effect of COVID-19 on the human body. Numerous questions remain unanswered, one of which involves the management of immunosuppression in the post-transplant recipient during this contagion. The core tenet of which continues to be that of establishing an equipoise between infection and rejection. This review summarises the current knowledge on immune interactions of the virus, the immunomodulatory effects that may be at play, and its relation to the art of immunosuppression.

Keywords: COVID-19; Post-transplant immunosuppression; Immunity; Review

Core Tip: As with other pathologies, the coronavirus pandemic is likely to have a complex pathophysiological interplay with the post-transplant recipients; one affecting the clinical course and outcome of the other. These fragile subset of patients, with their immunomodulated state are likely be affected in numerous ways which may not be limited to just a more rapid progression of infection. During this pandemic the need to weigh the benefits of immunosuppression relative to inflammation against its adverse effects remains.