When the novel coronavirus causing COVID-19 first emerged in 2020, the transplant community raced to create safety protocols for their solid organ transplant patients. Experience with the SARS and H1N1 pandemics served as a reminder that similar viral illnesses can wreak havoc in this vulnerable patient population.1 Shortly after the number of cases exponentially increased to pandemic status, clear evidence emerged that SARS-CoV-2 can cause profound and often fatal illness in these patients, independent of graft function. In the current issue of Polish Archives of Internal Medicine (Pol Arch Intern Med), Ślusarczyk et al2 present a retrospective review of their center’s experience with COVID-19 in kidney and liver transplant recipients. In their analysis, the authors report a 30% mortality rate in hospitalized kidney transplant recipients with COVID-19, which was higher than the observed 12.5% mortality rate in their small liver transplant cohort. They suggest that kidney transplant recipients may have more severe COVID-19 due to high baseline immunosuppression.

The observations of Ślusarczyk et al2 are not unique; they are part of a continuous reminder that COVID-19 is a legitimate threat to solid organ transplant patients. The focus should now be on identifying preventive treatment strategies and reporting outcomes associated with SARS-CoV-2–related therapies. The introduction of SARS-CoV-2 mRNA vaccines has been a welcome change to the COVID-19 pandemic, but the data for solid organ transplant patients have not been as promising. Despite the widespread utilization of these vaccines, transplant patients continue to experience the deleterious effects of the disease. The necessity of immunosuppression continues to be a double-edged sword, as transplant recipients have low antibody response to the vaccine compared with nonimmunosuppressed individuals.3,4 Cases of breakthrough infections following vaccination are also being widely reported,5,6 as the prevalence of the virus continues to increase due to viral mutations and lack of social distancing measures after the lifting of public restrictions. Additionally, vaccine hesitancy also plays an important role,7 further increasing the risk of this vulnerable cohort.

Despite the poor outcomes of COVID-19 in solid organ transplant recipients, the benefit of organ transplantation in patients with end-organ disease still outweighs the risk of the disease. Therefore, transplant centers should continue to provide transplantation during the COVID-19 pandemic. From monoclonal antibodies and investigational agents to vaccine boosters, therapies for COVID-19 continue to grow. It is essential to evaluate these outcomes in real time, as the dynamic landscape of COVID-19 can shift treatment strategies and influence public policy. More importantly, there is a need to continue the community effort of social distancing and vaccine implementation among the general population. Although significant challenges remain in the management of transplant patients with COVID-19, there is hope in the global effort to identify treatment modalities that can ultimately protect this patient population.