Despite the fact that 60% of these antibodies were donor-specific, no episodes of antibody or cellular rejection were identified while these antibodies were detectable [155]


Despite the fact that 60% of these antibodies were donor-specific, no episodes of antibody or cellular rejection were identified while these antibodies were detectable [155]. 24% of recipients at admission. The decrease in the estimated glomerular filtration rate was significantly more frequent in the remdesivir group (80%) compared with recipients with no antiviral treatment (29%). However, most individuals exhibited the repair of baseline kidney function within one month of discharge [80]. The successful management of severe COVID-19 pneumonia was reported in liver transplant recipients early after transplantation and treatment with remdesivir and convalescent plasma [81]. Another liver transplant recipient who suffered from COVID-19 with encephalopathy was successfully treated with remdesivir and convalescent plasma [82]. A case of a 67-year-old woman with respiratory failure that was VU 0364439 attributed to COVID-19 was explained 1 year after cardiac transplantation. A reduction of immunosuppression with supportive treatment, including convalescent plasma, remdesivir, and dexamethasone, resulted in the resolution of her symptoms within days [83]. Additionally, two heart transplant recipients were successfully treated with a combination of dexamethasone and remdesivir [84]. In conclusion, remdesivir was reported to be safe in SOT recipients, but its use may result in at least the temporary worsening of kidney allograft function. 4.2. Ivermectin Ivermectin, an antiparasitic drug, can potentially act upon some viruses by altering ionic balance between the internal and external environments, resulting in osmotic lysis [85]. The neurotoxicity of ivermectin, especially at high doses, may limit its medical use. Because of biased results from clinical studies, the WHO recommended against the use of ivermectin in COVID-19 SPRY4 individuals except in medical tests [77]. Ivermectin is not recommended in SOT recipients because it is known as a cytochrome P450 inducer that potentially alters CNI drug levels. 4.3. Immunotherapy to Reduce Cytokine Storm and Inflammatory-Mediated Organ Damage in COVID-19 Individuals who succumb to severe COVID-19 often present an imbalanced immune response with exacerbated swelling and dysregulated T cell activation and additional counteracting activities [86]. Thus, the use of anti-cytokine and immunomodulatory medication was postulated to diminish inflammatory-mediated organ damage in the general human population and SOT recipients. Immunomodulation offers appeared like a encouraging option for SOT recipients with severe COVID-19 illness, but the available evidence is mainly restricted to the anti-IL-6 drug tocilizumab [87]. The potential benefits and risks of immunomodulatory restorative options for COVID-19 in the general population relative to SOT recipients VU 0364439 are discussed below. 4.3.1. Glucocorticoids Restorative doses of glucocorticoids impact both innate and adaptive immunity by influencing the production of proinflammatory cytokines (e.g., IL-1, IL-2, IL-6, IL-12, and IL-17), migration of macrophages/leukocytes into local inflamed sites, and rules of Th1- and Th17-mediated cellular immunity and Th2-mediated humoral immunity. Glucocorticoids suppress cellular immunity but stimulate humoral immunity by altering the differentiation of CD4+ T cells and B cells and suppress IFN-I-mediated innate immunity by inhibiting their intracellular signaling pathways. Glucocorticoids increase the quantity of circulating neutrophils, enhance the opsonization of scavenger systems, and activate the phagocytosis of macrophages [88,89]. In COVID-19, glucocorticoids were reported to suppress virus-induced swelling and subsequent organ damage. Dexamethasone at a dose of 6 mg/day time for up to 10 days reduced mortality in COVID-19 individuals who received either invasive mechanical air flow or oxygen only at randomization but not in individuals who received no respiratory support [90]. SOT recipients are often treated chronically with glucocorticoids at least during the peri-transplant period. Thus, the use of dexamethasone or methylprednisolone as a part of anti-SARS-CoV-2 therapy is definitely unquestionable. Most anti-COVID-19 therapies are based on an VU 0364439 increase in temporary doses of glucocorticoids as a part of multi-drug treatment. A case series of four heart transplant recipients showed that they were successfully treated with dexamethasone (with.