Solid organ transplantations and COVID-19 disease

Table 1 Therapeutic agents used during solid organ transplantation period and their side effects

Agents	Mechanism	Side effects
IVIG	Reduces HLA sensitivity. The goal of the IVIG therapy is to lower the level of HLA antibodies and limit their ability to attack a transplanted organ	Headache, fever, urticaria, eczema, hypotension, anaphylactic shock, TRALI, immune thrombocytopenic purpura. Delayed side effects: Renal impairment, transfusion related infection
Glucocorticosteroids	Mimic the effects of cortisol side effects block T-cell derived and antigen presenting cell derived cytokine expression	Hypertension, hirsutism, susceptibility to infection, osteoporosis, necrosis, insulin resistance, growth retardation
Calcineurin inhibitors (cyclosporine, tacrolimus)	Inhibition the key signaling phosphatase calcineurin, which is an enzyme that activates T-cells of the immune system	Nephrotoxicity, promoting of the de novo cancers, metabolic disorders such as diabetes, dyslipidemia, gingival hyperplasia, hirsutism, hypertension, susceptibility to infection
Antiproliferative agents (Mycophenolic acid, azathioprine)	Inhibiting purine base synthesis and arresting T- and B-cell proliferation	Nausea, sleep disturbance, headache, constipation, diarrhea, weakness, fever, hematuria
mTOR inhibitors (sirolimus, everolimus)	Alternative for calcineurin inhibitors and antiproliferatives. T-cell proliferation inhibition. Binds to the specific cytosolic protein FKBP-12	Hypertension, hyperlipidemia, anemia or thrombocytopenia, headache, proteinuria, interstitial lung disease, mouth ulcers
Azathioprine	Decrease DNA and RNA synthesis reduce the production of lymphocytes	Nausea, hepatotoxicity, leukopenia, thrombocytopenia, malignancies

FKBP: FK506 (tacrolimus) binding protein; IVIG: Intravenous immunoglobulin; TRALI: Transfusion related acute lung injury; mTOR: Mechanistic target of rapamycin.