Ann Liver Transplant.  2021 Nov;1(2):129-134. 10.52604/alt.21.0022.

Immunosuppression for liver transplant recipients during the COVID-19 pandemic

• Park JI
• Jung BH

• KMID: 2560862
• DOI: http://doi.org/10.52604/alt.21.0022

Abstract

SARS-CoV-2 infection has resulted in a pandemic with serious consequences for worldwide health care system. Liver transplant recipients manifest immunosuppressed status and are theoretically more vulnerable to infection, suggesting the need to modify the immunosuppressive regimens according to the patient status and the treatments used. This study intended to present the action mechanisms of immunosuppressive agents and show the balance between immunosuppressive effects and antiviral agents in relation to immunosuppressive treatment in patients with COVID-19 infection. In the absence of robust evidence to support general recommendations, experience with other viral infections suggests the benefit of management of immunosuppression without mycophenolate mofetil or mammalian target of rapamycin inhibitors. It is also important to consider the possible drug interactions, especially in the case of tacrolimus, with a few antiviral treatments in the context of COVID-19. The immunosuppressive effect of immunomodulating drugs administered to patients with severe lung disease also should be taken into account. The present study reviews the mechanisms of action of the different immunosuppressive agents, as well as their potential effect on SARS-CoV-2 infection. Guidelines for the management of immunosuppression in liver transplant recipients are suggested.

Keyword

SARS-CoV-2; Immunosuppression; Immunomodulation; Cytokines; Pneumonia; Liver transplantation