SARS-CoV-2 infection dynamics in a MHCI-mismatched lung transplant recipient
A 48-year-old patient underwent lung transplantation because of severe COVID-19, which aggravated his underlying interstitial lung disease, despite the presence of detectable SARS-CoV-2. Subsequently, the graft is re-infected early in the post-procedural phase, leading to viral persistence for more than five months. By analyzing viral evolution and effector immune response within the transplanted organ, we observe three main findings. First, virus evolution differs in the transplanted organ compared to that in the upper respiratory tract and is affected by monoclonal SARS-CoV-2-specific antibodies and molnupiravir. Second, we show the potential clinical relevance of T cell HLA restriction that may facilitate viral clearance in the upper respiratory tract compared to the ongoing viral replication in the HLA mismatch organ. Third, close monitoring and modulation of immunosuppressive and antiviral therapy enables viral clearance in a lung transplantation setting despite incomplete SARS-CoV-2 clearance prior to transplantation.
Authors
- Bernward Passlick (ORCID: https://orcid.org/0000-0002-4684-0625)
- Nils Venhoff (ORCID: https://orcid.org/0000-0001-7729-2759)
- Alain Kohl (ORCID: https://orcid.org/0000-0002-1523-9458)
- Daiana Stolz (ORCID: https://orcid.org/0000-0003-0099-882X)
- Björn C. Frye (ORCID: https://orcid.org/0000-0003-3520-1868)
- Daniel Eckert
- Daniel Hornuß (ORCID: https://orcid.org/0000-0002-2621-3341)
- Andreas Kremser
- Charlott Terschluse
- Inga Lau
- David Schibilsky (ORCID: https://orcid.org/0000-0002-7597-7778)
- Isabelle Moneke (ORCID: https://orcid.org/0000-0002-1019-5214)
- I Hettich
- Annabelle Flügler
- Christoph Neumann‐Haefelin (ORCID: https://orcid.org/0000-0001-7351-1387)
- Johannes Kalbhenn (ORCID: https://orcid.org/0000-0001-7551-5082)
- Daniela Huzly (ORCID: https://orcid.org/0000-0002-1641-5943)
- Martin Czerny (ORCID: https://orcid.org/0000-0003-4766-9775)
- Achim Lother (ORCID: https://orcid.org/0000-0001-9107-5558)
- Vivien Karl (ORCID: https://orcid.org/0000-0001-7026-7622)
- Jonas Fuchs (ORCID: https://orcid.org/0000-0003-1974-212X)
- Georg Kochs (ORCID: https://orcid.org/0000-0003-0187-559X)
- Gernot Zissel (ORCID: https://orcid.org/0000-0001-8021-9798)
- Maike Hofmann (ORCID: https://orcid.org/0000-0001-8410-8833)
- Nikolaus Kneidinger (ORCID: https://orcid.org/0000-0001-7583-0453)
- Robert Thimme (ORCID: https://orcid.org/0000-0003-1417-4135)
- Marcus Panning (ORCID: https://orcid.org/0000-0003-3596-5964)
- Lena Jaki (ORCID: https://orcid.org/0000-0001-9732-181X)
- Florian Emmerich (ORCID: https://orcid.org/0000-0002-1099-9634)
- Sebastian Fähndrich (ORCID: https://orcid.org/0000-0001-9910-2063)
- Anastasija Maks
- Jaime Alvarado (ORCID: https://orcid.org/0000-0001-6634-8024)
- Prerana Agarwal (ORCID: https://orcid.org/0000-0002-6784-6727)
- Elisabeth Schygulla
Institutions
- University of Freiburg (DE)
- University of Lucerne (CH)
- University of Cologne (DE)
- Medical University of Graz (AT)
- University Medical Center Freiburg (DE)
- LMU Klinikum (DE)
- German Center for Lung Research (DE)
- University Hospital Cologne (DE)
- Ludwig-Maximilians-Universität München (DE)
Publication Details
- Journal
- Nature Communications
- Published
- 2025-09-16
- DOI
- https://doi.org/10.1038/s41467-025-63681-y
- Primary Topic
- SARS-CoV-2 and COVID-19 Research
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- Deutsche Forschungsgemeinschaft
- Albert-Ludwigs-Universität Freiburg
- Medizinische Fakultät der Albert-Ludwigs-Universität Freiburg