SOLID organ transplant (SOT) recipients face a heightened risk of severe outcomes from SARS-CoV-2 infection, yet clinical evidence specific to this vulnerable group remains limited. A new Delphi consensus has now outlined evidence-informed recommendations to help standardize diagnostic and therapeutic management in this population.
The consensus was developed as part of the ORCHESTRA study, a multinational initiative aimed at addressing gaps in COVID-19 care for fragile patient groups. A working group of infectious disease and pharmacology specialists first conducted a comprehensive review across five domains: risk stratification for severe disease, optimal diagnostic use, therapeutic management with a focus on antivirals and drug interactions, modification of immunosuppressive regimens, and considerations for transplantation in the setting of active or recent infection.
Based on this analysis, the investigators designed a 28-item questionnaire administered to an expert panel of 21 specialists from Europe, the United States, and Brazil. Using the Delphi methodology, the panel reached consensus on 27 items across two rounds of review. These agreements were distilled into 10 key consensus statements, which together provide a practical framework for physicians managing SOT recipients during COVID-19.
The statements address critical aspects of care, including when to implement targeted screening, how to balance antiviral therapies with immunosuppressive regimens, and how to evaluate donor and recipient suitability in cases of recent infection. The guidance also weighs the cost–benefit implications of diagnostic strategies and provides direction on drug–drug interactions that are particularly relevant in transplant medicine.
Although not a substitute for randomized clinical trial evidence, the authors emphasize that these consensus statements represent the best available synthesis of expert opinion and literature to date. For clinicians navigating the complexities of COVID-19 in transplant patients, the recommendations offer structured support for decision-making in a setting where individualized care and multidisciplinary expertise are essential.
Reference: Tazza B et al. ORCHESTRA Delphi consensus: diagnostic and therapeutic management of SARS-CoV-2 infection in solid organ transplant recipients. Clin Microbiol Infect. 2025;31(8 Suppl):S3-S13.
