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Content Update

July 12, 2022

Challenges in Managing COVID-19 Vaccination in Solid Organ Transplant: As the COVID-19 pandemic has rapidly evolved, the solid organ transplant community has been faced with many challenges. Solid organ transplant recipients have an increased risk of developing severe disease when infected with COVID-19 due to immunosuppression and additional comorbidities. Vaccination is a key strategy in preventing and reducing the severity of COVID-19. Various studies evaluating vaccine efficacy have shown responses to the COVID-19 vaccine are diminished in solid organ transplant recipients compared to the general population. To increase immunogenicity and decrease the possibility of a breakthrough infection, the American Society of Transplantation currently recommends solid organ transplant recipients complete a three-dose primary series and receive two additional boosters.



Upon completion of the chapter, the reader will be able to:

  1. Describe the reasons for solid organ transplantation.

  2. Differentiate between the functions of cell-mediated and humoral immunity and how they relate to organ transplant.

  3. Describe the roles of antigen-presenting cells (APCs) in initiating the immune response.

  4. Compare and contrast the types of rejection including hyperacute, acute, chronic, and antibody-mediated rejection.

  5. Define the terms “host–graft adaptation” and “tolerance,” paying close attention to their differences.

  6. Discuss the desired therapeutic outcomes and appropriate pharmacotherapy utilized to avoid allograft rejection.

  7. Compare and contrast currently available immunosuppressive agents in terms of mechanisms of action, adverse events, and drug–drug interactions (DDI).

  8. Develop a therapeutic drug-monitoring plan to assess the efficacy and safety of immunosuppressive drugs.

  9. Design an appropriate therapeutic regimen for the management of immunosuppressive drug complications based on patient-specific information.

  10. Write appropriate patient education instructions and identify methods to improve medication adherence following transplantation.


In the early 1900s, French surgeon Alexis Carrel pioneered the art of surgical techniques for transplantation.1 Together with Charles Guthrie, Carrel experimented in artery and vein transplantation. Using revolutionary methods in anastomosis operations and suturing techniques, Carrel laid the groundwork for modern transplant surgery. He was one of the first to identify the dilemma of rejection, an issue that remained insurmountable for nearly 50 years.1

Prior to the work of Carrel, malnourishment was the prevailing theory regarding the mechanism of allograft rejection.1 However, in 1910, Carrel noted tissue damage in the transplanted organ was likely caused by multiple, circulating biological factors. It was not until the late 1940s, with the work of Peter Medawar, that transplant immunology became better understood. Medawar defined the immunologic nature of rejection using skin allografts. In addition, George Snell observed that grafts shared between inbred animals were accepted but were rejected when transplanted between animals of different strains.1

The seminal work by early transplant researchers eventually led to the concept of histocompatibility.1 Histocompatibility describes the process by which polymorphic genes ...

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