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

Author

Listed:
  • Jonas Fuchs

    (University of Freiburg)

  • Vivien Karl

    (University of Freiburg
    University of Freiburg)

  • Ina Hettich

    (University of Freiburg)

  • Jaime Alvarado

    (University of Freiburg)

  • Daniel Eckert

    (University of Freiburg)

  • Lena Jaki

    (University of Freiburg)

  • Ann-Kathrin Kohl

    (University of Freiburg)

  • Anastasia Kremser

    (University of Freiburg
    University of Freiburg)

  • Anastasija Maks

    (University of Freiburg)

  • Charlott Terschluse

    (University of Freiburg
    LMU Munich)

  • Prerana Agarwal

    (University of Freiburg)

  • Florian Emmerich

    (University of Freiburg)

  • Sebastian Fähndrich

    (University of Freiburg)

  • Annabelle Flügler

    (University of Freiburg)

  • Daniel Hornuss

    (University of Freiburg)

  • Johannes Kalbhenn

    (University of Freiburg)

  • Nikolaus Kneidinger

    (Medical University of Graz
    Member of the German Center for Lung Research (DZL))

  • Inga Lau

    (University of Freiburg)

  • Achim Lother

    (University of Freiburg
    University of Freiburg)

  • Isabelle Moneke

    (Medical Center-University of Freiburg)

  • David Schibilsky

    (University of Freiburg
    Lucerne Cantonal Hospital)

  • Elisabeth Schygulla

    (University of Freiburg)

  • Nils Venhoff

    (University of Freiburg)

  • Gernot Zissel

    (University of Freiburg)

  • Martin Czerny

    (University of Freiburg)

  • Daniela Huzly

    (University of Freiburg)

  • Georg Kochs

    (University of Freiburg)

  • Christoph Neumann-Haefelin

    (University of Freiburg
    University of Cologne)

  • Bernward Passlick

    (Medical Center-University of Freiburg)

  • Daiana Stolz

    (University of Freiburg)

  • Robert Thimme

    (University of Freiburg)

  • Marcus Panning

    (University of Freiburg)

  • Maike Hofmann

    (University of Freiburg)

  • Björn C. Frye

    (University of Freiburg)

Abstract

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.

Suggested Citation

  • 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, 2025. "SARS-CoV-2 infection dynamics in a MHCI-mismatched lung transplant recipient," Nature Communications, Nature, vol. 16(1), pages 1-13, December.
    • Handle: RePEc:nat:natcom:v:16:y:2025:i:1:d:10.1038_s41467-025-63681-y
    DOI: 10.1038/s41467-025-63681-y
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