The data on the outcomes of solid organ transplant recipients who have contracted coronavirus disease 2019 (COVID-19) are still emerging. Kidney transplant recipients are commonly prescribed renin-angiotensin-aldosterone system (AAS) inhibitors given the prevalence of hypertension, diabetes, and cardiovascular disease. As the angiotensin-converting enzyme 2 (ACE2) facilitates the entry of coronaviruses into target cells, there have been hypotheses that preexisting use of renin-angiotensin-aldosterone system (RAAS) inhibitors may increase the risk of developing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Given the common use of RAAS inhibitors among solid organ transplant recipients, we sought to review the RAAS cascade, the mechanism of SARS-CoV-2 entry, and pertinent data related to the effect of RAAS inhibitors on ACE2 to guide management of solid organ transplant recipients during the COVID-19 pandemic. At present, there is no clear evidence to support the discontinuation of RAAS inhibitors in solid organ transplant recipients during the COVID-19 pandemic.

Non-alcoholic fatty liver disease is projected to be the most common cause of liver failure in the coming decade and is a very common reason for liver transplantation. One measure of its severity is the level of hepatic fibrosis, traditionally assessed by a liver biopsy. The non-alcoholic fatty liver disease fibrosis score was developed to non-invasively predict the degree of fibrosis using patient characteristics and laboratory values. We hypothesized that this score could also be used to assess the quality of donated livers, since many donors are obese and thus have a higher risk of fatty liver disease. Using data from the United Network for Organ Sharing over two decades, this study tests whether graft failure is associated with the donor liver’s non-alcoholic fatty liver disease fibrosis score. Statistical analysis yielded that the relationship between the score and time till graft failure is insignificant: A chi-square test of independence between the two gives a p-value of .1311, and a Kaplan-Meier survival analysis yielded a p-value of .2, neither of which were under the significance level of .05. Though the results were not statistically significant, future studies on non-invasive assessments and their use may illuminate possibilities for clinical applications.