Here we report a single-center cohort of 6 patients (4 kidney-only, and 2 simultaneous liver/kidney transplants) diagnosed with COVID-19 at a median of 1.9 years (range=0.2-9.3 years) post-transplant. Five (of 6) patients required inpatient admission, two patients (mortality=33%) died. Among those with mortality, an increased concentration of inflammatory biomarkers [interleukin-6 (IL6) and C-reactive protein] was noted with a lack of response to IL-6 blockade, remdesivir and/or convalescent plasma. None of the kidney-only transplants (4/6; 67%) had elevation in plasma donor-derived cell-free DNA above the previously published cut-off of 1% suggesting absence of significant allo-immune injury. Four (of 5) admitted patients had detectable SARS-CoV-2 (severe acute respiratory syndrome–coronavirus 2) in blood on samples obtained at/during hospitalization. Of the 4 discharged patients, two patients with undetectable virus on repeat nasopharyngeal swabs had seroconversion with positive SARS-CoV-2 IgG formation at 30-48 days post-infection. One patient had prolonged shedding of virus on nasopharyngeal swab at 28 days post-discharge despite lack of symptoms. In this preliminary report, we find that immunocompromised transplant patients had higher rates of RNAemia (67%) than reported in the general population (15%), seeming absence of allo-immune injury despite systemic inflammation and formation of IgG overtime after recovery from infection.

The efficacy of vaccinations among vulnerable populations such as solid organ transplant recipients on chronic immunosuppression have been suboptimal compared to the general population 1‐2 . Preliminary data suggests the humoral response rate for solid organ transplant patients who have received both doses of SARs‐CoV‐2 mRNA vaccine, either mRNA‐1273 (Moderna) or BNT162b2 (Pfizer‐BioNTech), is roughly 54% 3 . However, the clinical implications and real life impact of this is still unknown.

Through the lens of apple growing and by employing a social-ecological systems approach, this paper seeks to understand how identity and biodiversity both contribute to place formation. This paper compares two apple-growing regions, Jumla in Nepal and Harcourt in Australia by analysing qualitative interviews and historical documents. The study finds that identity and place play an important role in the way growers interact with their local landscapes. This paper argues that sustainable landscapes can be realised through diverse production systems that adhere to physical place limitations and also adapt to longterm changes in social and physical conditions.

Information regarding Coronavirus disease 2019 in the transplant population is lacking. Recently it has been suggested that cycle threshold values obtained on polymerase chain reaction tests may serve as a marker of disease severity with lower values (i.e., higher viral load) being associated with higher mortality. This study was done to assess the impact of remdesivir use on the time to a negative COVID-19 PCR as well as the degree of change between two Ct’s based on treatment. A total of 30 kidney transplant patients with a new diagnosis of COVID-19 were assessed. Serial PCR results were followed from the time of diagnosis then every 2–4 weeks until negative. In patients who received remdesivir immediately after COVID-19 confirmation compared to no remdesivir, time to negative PCR was not statistically different with a median duration of 57 days in both groups (p = 0.369). The change in the Ct between the first and the second PCR test was also not statistically different between groups with a median change of 18.4 cycles in the remdesivir group and 15.7 cycles without remdesivir (p = 0.516). The results of this small single-center analysis suggest that remdesivir may not be beneficial in shortening time to a negative COVID-19 PCR.

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