Persistent Viral Detection After Resolution of COVID-19 in Lung Transplant Recipients

INTRODUCTION: Persistent detection of SARS-CoV-2 viral particles has been seen in the absence of symptoms in other solid organ transplant recipients. We report this unique phenomenon in lung transplant (LTx) recipients. CASE REPORT: We present the following cases of prolonged viral shedding in 3 LTx recipients: Patient A - 68-year-old female, bilateral LTx recipient for COPD (02/2020), Patient B - 65-year-old male, bilateral LTx recipient for IPF (07/2020), and Patient C - 64-year-old female, bilateral LTx recipient for COPD (08/2020). There were no major intraoperative complications, and the maintenance immunosuppression regimen was the same across patients. Patient A contracted COVID-19 at our center 10 months after transplant, reporting upper respiratory infection symptoms, after initially presenting with persistent headaches and diagnosed with posterior reversible encephalopathy syndrome. Patients B and C presented to clinic with myalgias and mild dyspnea at one and five months after transplant, respectively. SARS-CoV-2 was detected by RT-PCR of nasopharyngeal specimens in all patients. Chest CT demonstrated typical findings of COVID-19 pneumonia in all patients. Patients A and C received remdesivir and belatacept and were discharged home on days 5 and 7, respectively; Patient B received remdesivir and convalescent plasma and was discharged home on day 8. All were in stable clinical condition on room air. All 3 patients had persistently positive nasopharyngeal swab samples up to four weeks after hospitalization, despite absence of symptoms. We did not augment immunosuppression in these patients. Imaging findings during and after the infectious course are shown in Figure 1. Patient C has persistent lower lobe radiographic changes after COVID-19. SUMMARY: LTx recipients may exhibit prolonged viral shedding up to at least 1 month despite resolution of symptoms. Well-established cohort studies are needed to elucidate the full duration of viral shedding in this group.