Viral rebound frequent in lung transplant recipients handled with nirmatrelvir/ritonavir for COVID-19

Information on the viral rebound and security of nirmatrelvir/ritonavir in lung transplant (LTx) recipients are restricted. The examine prospectively adopted 4 LTx recipients. Scientific traits, viral RNA dynamic in throat swabs, and tacrolimus blood focus had been monitored repeatedly. All 4 LTx recipients, aged 35–74 years, weren’t vaccinated in opposition to extreme acute respiratory syndrome coronavirus 2 (SARS-CoV-2). They received coronavirus illness 2019 (COVID-19) after a couple of week of admission in the course of the period of Omicron.

All instances obtained nirmatrelvir/ritonavir (NM/r) inside two days of an infection, and the relative viral RNA copies dropped rapidly. Viral load rebound was noticed in all 4 instances after discontinuation of the primary 5 days of NM/r therapy. Three of them obtained one other 5-days antiviral remedy with NM/r. The length of constructive viral PCR testing was 25-28 days. None of them progressed into extreme or essential COVID-19. Tacrolimus was stopped 12 h earlier than NM/r and held in the course of the 5-day course of antiviral remedy. Blood focus of tacrolimus had been maintained at a baseline stage throughout these 5 days.

Tacrolimus was re‐initiated at its baseline every day dose 3-4 days after NM/r remedy. Nonetheless, in the course of the second spherical of antiviral remedy with NM/r, the focus of tacrolimus fluctuated wildly. In conclusion, the 5-day course of NM/r therapy was not ample for LTx recipients and the viral rebound was frequent. Extra knowledge are wanted to make clear whether or not LTx recipients with SARS-CoV-2 viral rebound may benefit from further therapy with NM/r.