*Purpose: The treatment of SARS-CoV-2 associated pneumonia in solid organ transplant recipients (SOTr) continues to be under investigation. Timely control of the cytokine release storm (CRS) in its early stage is of essence to improving treatment of adult respiratory distress syndrome (ARDS). We report here the results of the use of therapeutic plasma exchange (TPE) as adjunct therapy for the management of SOTr.

*Methods: Single-center, retrospective cohort study of SOTr diagnosed with SARS-CoV-2 infection from March 1st to September 30th, 2020. All patients received severity stratified institutional protocolized treatment and TPE was started based on clinical and inflammatory parameters of CRS and ARDS. CRP, Ferritin, D-Dimer IL-6, IL10, TNF-A, IFN-G and TGF-A were measured pre and after completion of the treatment.

*Results: Of the 129 COVID-19 positive SOTr during the study period, 27 (21%) developed ARDS requiring the use of TPE. Baseline characteristics are shown in Table 1. The median time from transplant to infection was 287 (12-3593) days and the mean ICU stay was 13.5 ( 8-57) days. All patients had ARDS and reduction of baseline Immunosuppression. The management and results are shown in Table 2. The mean dose of TPE was 5 (3-20) sessions. Our data showed a down trend in measured cytokines achieved at the end of the TPE treatment. The mean ± SD pre and post TPE CRP level were 15.95 ± 9.4 and 2.30 ± 5.80. The post treatment CRP correlated with improvement in oxygen requirements with HR of death of 1.35. Patient and graft survival were 62.9 and 96.3% respectively.

*Conclusions: The supportive use of TPE in severe SARS-CoV-2 associated CRS and ARDS appears to improve oxygen requirements and prognosis. More research is warranted to confirmed our findings.

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