Author, ref. and date

Solid organ year of transplant

Age (y)

Sex

(m/f)

IST

Symptoms at presentation

Temp

SpO₂

CRP

CT chest

Severity Stage (Siddiqi)

Treatment

Outcome

Li F, et al. [47]

Heart,

2003

51, m

Tac

MMF

intermittent fever

chills

fatigue

poor

appetite

diarrhea

38.5

99%--> 75%

18.6 mg/L

GGO (bilat.)

IIA --> IIB

levofloxacin iv

ribavirin iv

moxifloxacin iv

ganciclovir iv

IVIG

methylprednisolone iv

moxifloxacin po

umifenovir

Tac and MMF stopped from day 7-13

survived, hospitalization 27 days, no mechanical ventilation or ECMO, CT at discharge improved (residual lesions).

Li F, et al. [47]

Heart,

2017

43, m

Tac

MMF

fever (2 days)

fatigue

poor

 appetite

38.5

normal SpO₂?

13.4 mg/L

GGO (bilat.)

IIA

ceftriaxone iv

ganciclovir iv

moxifloxacin po

arbidol po

survived, hospitalization 11 days, no mechanical ventilation or ECMO

Kates O, et al. [48]

Heart,

1997

74, m

Tac

Mes

sore throat

dry cough

40,

SpO₂ and CRP unknown

CXR normal

I

immunosuppression unchanged

survived

no hospitalization

Hsu JJ, et al. [15]

Heart and Kidney,

2017

39, m

Tac

MMF

Pred

fever

headache

sore throat

dry cough

dyspnea

fatigue

myalgias

38.8

97%

67 mg/L

CXR mild congestion

I --> IIB

Tac unchaged

MMF stopped

Pred continued

survived, hospitalization 15 days

Zhu L, et al. [49]

Kidney, 2008

52, m

Tac

MMF

Pred

fatigue

dyspnea

chest pain tightness

nausea

loss of

 appetite

abdominal

 pain

dry cough

fever

headache

38.9

96%

30.2 mg/L

GGO (bilat.)

IIA

umifenovir

methylprednisolone

interferon-a inh.

IVIG

biapenem

pantoprazole

Tac stopped from day 6-11, reintroduced with 50% reduction for 7 days, followed by normal doses

MMF stopped from day 6-11, reintroduced by normal dose after 12 days

pred stopped during hospitalization

survived, hospitalization 12 days, no mechanical ventilation or ECMO

Guillen E, et al. [50]

Kidney, 2016

50, m

Tac

Everol

Pred

fever

vomiting

37.4

98%

13.2 ml/L

unilateral --> bilat. infiltrate

IIA--> IIB

ceftriaxone

azithromycin

lopinavir/ritonavir

HCQ

TAC and everol temporary stopped due to interactions

interferon-b

intubation and MV

Gandolfini I, et al. [51]

Kidney, 2010

75, m

Tac

Pred

MMF

Fever

Cough

Myalgia

Dyspnea

38.0

SpO₂ and CRP unknown

GGO

IIB

NIV

HCQ

Lopinavir-ritonavir or darunavir-cobicistat

died

Gandolfini I, et al. [51]

Kidney, 2019

52, f

Tac

Pred

MMF

Fever

Cough

Myalgia

Dyspnea

39.0

SpO₂ and CRP unknown

GGO

IIB

NIV

HCQ

Lopinavir-ritonavir or darunavir-cobicistat

Colchicine

alive

Bartiromo M, et al. [28]

Kidney, 1993

36, f

Tac

Pred

Fatigue

Dry cough

Coryza

36.3

SpO₂ 99%

CRP 67

CXR infiltrates

IIA

lopinavir/ritonavir, later replaced by

darunavir/cobicistat

Tac unchanged, but developed extremely high level, stopped after discharge

survived after 9 days hospitalization

Marx D, et al. [52]

Kidney, 2017

58, m

Bela

MMF

Pred

Fever

Mild dyspnea

Cough

38

SpO₂ 96%

GGO

IIA

Bela stop

MMF stop

survived after 16 days hospitalization

Husain SA, et al. [53]

Kidney

Case Series n = 15

51 (21-78), 5 f, 10 m

Tac

MMF

Bela

Leflu

Aza

Pred

Fever

Cough

Fatigue

Malaise

Dyspnea

Diarrhea

Myalgia

Hemoptysis

Emesis

CXR bilateral opacities (n = 7, 47%), no acute findings (n = 5, 33%), lobar infiltrate (n = 2, 14%)

Antimetabolites or leflunomide stop (n = 10, 71%)

Tac unchanged

Pred unchanged (n=14, 71%))

Replaced Tac and MMF with pred (n=1, 7%)

Died (n = 1, 7%)

Intubation (n=4, 27%)

ZhuL, et al. [54]

Kidney

Case Series n = 10

45 (24-65), 2 f, 8 m

CNI, MM, pred

GGO and/or consolidation

Different regimes, patients on CNI, MMF, pred

Died (n=1, 10%)

Fontana F, et al. [12]

Kidney,

2005

61, m

CyA

MTP

Fever

38

SpO₂ 97%

CRP 41

GGO bilat.

IIA--> IIB

CyA 50% reduced

HCQ

MTP increased

Tocilizumab

IVIG

Meropenem

Survived, hospitalization 22 days

Kates O, et al. [48]

Kidney,

2000

54, m

Tac

MMF

Fatigue

Dry cough

Dyspnea

Nausea

Vomiting

Diarrhea

38

SpO₂ 93%

CRP unknown

CXR multifocal infiltrates

IIB

MMF discontinued

Tac reduced

Pred 10 mg started

Ceftriaxon

Azithromycin

HCQ

survived, hospitalization 16 days

Arpali E, et al. [55]

Kidney

2020

28, f

Tac

MMF

Pred

Fever

38

SpO₂ unknown

CRP 4.5

CXR normal

I

immunosuppression unchanged

survived, hospitalization 1 day

Zhong Z, et al. [56]

Kidney,

48, m

Tac

MMF

cough

muscle aches

fatigue

chest tightness

37.8

31 mg/L

GGO

IIA

Tac unchanged

MMF discontinued

oseltamivir

abidol

moxifloxacin

rh-IFNa

MMP

IVIG

survived, hospitalization 34 days

Qin J et al. [57]

Liver,

2020

37, m

Tac

Pred

unknown

Temp, SpO₂ and CRP unknown

GGO

IIB

Tac and Pred maintained, gradually titrated to lower doses

HFOT

Oseltamivir

rh-GCSF

IVIG

survived, hospitalization 2 months (including liver transplantation)

Lagana SM, et al. [58]

Liver,

2020

0.5, f

Fever

Dyspnea

Diarrhea

"fever"

CXR bilat. infiltrates

IIA

CPAP

HCQ

Pred tapering

MMF stopped

alive

Huang JF, et al. [59]

Liver,

2017

59, m

Tac

MMF

Fever

Cough

Chills

Fatigue

Diarrhea

40.0

SpO₂ normal

CRP 35.1

GGO

IIA-->IIB --> III

pip/taz

lopinavir/ritonavir

alpha-IFN (nebul.)

Tac & MMF reduced (50%) (possible drug-drug interactions with lopinavir/ritonavir)

cefperazone-sulbactam and caspofungin

day 4: IIB, nasal oxygenation, standard methylprednisolone

day 9: invasive ventilation

day 12: PTx + PE, drainage

day 15: ECMO

Kidney failure

day 45: died

Kates O, et al. [48]

Liver

2001

67, m

CyA

Fatigue

Confusion

Dry cough

Diarrhea

Temp, SpO₂ and CRP unknown

CXR normal

IIB

CyA continued

survived, hospitalization 12 days

Zhong Z, et al. [56]

Liver

37, m

Tac

MTP

unknown

38.6

93%

CRP unknown

GGO

IIA

Tac discontinued

MTP

survived

hospitalization duration unknown

Steinack C, et al. [9]

Lung,

2019

(bilat.)

55, f

Tac

MMF

Pred

Nausea

Vomiting

Diarrhea

Dry cough

Rhinorrhea

38.9

96%

77 mg/L

3 nodular lesions

IIA

piperacillin/tazobactam

survived

hospitalization 12 days

Aigner C, et al. [60]

Lung

(bilat.)

2019

59, f

Tac

Pred

Asymptomatic

Afebrile

Hypoxemia (pO₂ 55 mmHg)

GGO

IIB

Meropenem

Tac and Pred unchanged

survived

hospitalized 21 days

Shigemura N, et al. [61]

Lung

(bilat.)

2020

Elderly, m

Tac

Pred

Fever

38.1

90%

GGO

IIB --> III

Tac and Pred continued

MMF withheld immediately

remdesivir

intubation

died, 11 days posttransplant

Shigemura N, et al. [61]

Lung

(unilat.)

2020

Elderly, m

Information pending

Severe abdominal pain, watery stool

Afebrile

GGO in native lung, no GGO in donor lung

IIB

remdesivir

clinically stable, with nasal cannula with 3LO2/min.

(follow-up awaited)

Kates O, et al. [48]

Lung

(bilat)

2000

53, f

CyA

Aza

Pred

Fatigue

Dry cough

Dyspnea

Temp, SpO₂ and CRP unknown

I

none, immunosuppressive therapy continued

survived

no hospitalization