Vaccination with >2 Doses of Mrna Vaccines is Needed to Reduce Mortality Among Lung Transplant Recipients with Covid-19

Vaccination reduces COVID-19-related morbidity and mortality in the general population, however, the response to vaccination is attenuated among immunosuppressed lung transplant recipients (LTR). Boyarski et al noted that 61% of LTR had no serologic response to the first or second dose of mRNA vaccines, with an additional 31% only responding to the second dose. We sought to compare the impact of vaccination status on COVID-19-related morbidity and mortality in LTR. We conducted a retrospective chart review of LTR with COVID-19 that did not receive Tixagevimab-Cilgavimab (Tix-Cil) prophylaxis. We compared outcomes based on vaccination status using chi-square and binomial exact tests. Between March 2020 and August 2022, 195 LTR developed COVID-19, 24 received Tix-Cil and were excluded from the analysis. The median age was 66.6 (58.8-71.9), 100 (58.5%) were male, 166 (97.1%) had a bilateral lung transplant, 91 (53.2%) had diabetes, 55 (32.2%) were obese, and 126 (73.7%) had chronic kidney disease with an eGFR <60. The most common immunosuppressive regimen included mycophenolate mofetil, tacrolimus, and prednisone (124 (72.5%)). The median percent predicted FEV1 was 78% (IQR 62, 94) and the median time from LT to COVID-19 diagnosis was 38.3 months (IQR 20.3, 66.9). LTR with COVID-19 that received at least 2 doses of the mRNA vaccines were less likely to be hospitalized compared to their unvaccinated counterparts. However, 2 vaccine doses alone did not reduce ICU admission, intubation, or mortality. LTR with COVID-19 that received >2 vaccines were less likely to be hospitalized, admitted to the ICU, or intubated, and had a lower mortality. Two doses of mRNA vaccines reduced COVID-19-related hospitalization among LTR with COVID-19;additional vaccine doses were needed to reduce risk of ICU admission, intubation, and death. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Pre-Exposure Prophylaxis with Tixagevimab-Cilgavimab May Not Reduce Covid-19 Severity Among Lung Transplant Recipients That Develop Breakthrough Infection

Tixagevimab-cilgavimab (Tix-Cil) is a long-acting monoclonal antibody combination granted Emergency Use Authorization approval for COVID-19 pre-exposure prophylaxis (PrEP) in immunocompromised patients, due to their suboptimal response to vaccination. We sought to determine whether Tix-Cil reduces COVID-19 severity among lung transplant recipients (LTRs) who develop breakthrough infection. After IRB approval, we conducted a retrospective chart review of LTRs who developed COVID-19 during the Omicron surge (December 2021 to August 2022). We performed comparative analyses using Fisher's exact test and logistic regression to control for vaccination and other monoclonal antibodies. A total of 89 LTRs with COVID-19 were included. The median time from LT to COVID-19 diagnosis was 38.3 months (IQR 20.3, 66.9). The median age was 67.4 years (59.5-72.4), 49 (55.1%) were male, 87 (97.8%) had undergone bilateral LT, 48 (53.9%) had diabetes, 25 (28.0%) were obese (body mass index ≥30 kg/m2), and 67 (75.3%) had chronic kidney disease (eGFR <60 mL/min/1.73m2). The most common immunosuppressive regimen included mycophenolate mofetil, tacrolimus, and prednisone (64;71.9%), and the median percent predicted FEV1 was 87% (IQR 64.5, 99.5). The overwhelming majority of patients received at least 2 doses of an mRNA vaccine (84 (94.3%)) and 60 (67.4%) were treated with monoclonal antibodies, 51 (57.3%) with antivirals, and 82 (92.1%) with increased corticosteroids upon COVID-19 diagnosis. Despite Tix-Cil prophylaxis, 24 LTRs contracted COVID-19 during the Omicron surge. The median time from Tix-Cil to COVID-19 diagnosis was 90.5 days (60.3, 119.0). PrEP with Tix-Cil did not reduce hospitalization, ICU admission, need for mechanical ventilation or death among LTRs. Pre-exposure prophylaxis with Tix-Cil may not reduce COVID-19 severity among LTRs that develop breakthrough infection. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Covid-19 is Less Severe with the Omicron Variant Compared to Prior Variants and the Original Sars-Cov-2 Strain in Lung Transplant Recipients

Multiple variants of SARS-CoV-2 have been documented throughout the COVID-19 pandemic. Mutations that lead to these variants can affect viral spread, disease severity, and the efficacy of vaccines and therapeutics. Lung transplant (LT) recipients (LTRs) are at high risk of COVID-19-related morbidity and mortality;however, disease severity may differ between SARS-CoV-2 variants. We sought to describe the clinical outcomes of LTRs with COVID-19 at different stages of the pandemic. We performed a retrospective chart review of LTRs with COVID-19 and categorized them into 4 groups according to the prevalent variant on the date of the positive test. Chi-square and non-parametric binomial exact tests were used for comparative analyses. Since March 2020, 195 LTRs at our institute developed COVID-19;the median age was 66.6 years (58.7-72);114 (58.5%) were male;190 (97.4%) had received a bilateral LT;106 (54.4%) had diabetes;63 (32.3%) were obese;and 145 (74.4%) had chronic kidney disease with an eGFR <60. The most common immunosuppressive regimen included mycophenolate mofetil, tacrolimus, and prednisone (n=142;72.8%). The median percent predicted FEV1 was 81% (IQR 63-96) and the median time from LT to COVID-19 diagnosis was 37.3 months (IQR 18.5-66.7). Rates of hospitalization, ICU admission, need for mechanical ventilation, and death were significantly lower for the Omicron variant than the original strain, the Alpha variant, and the Delta variant. However, there was no difference in length of hospital stay, development of extrapulmonary end-organ dysfunction, or persistent drop in spirometric flows (Table 1). Lastly, the utilization of vaccination and monoclonal antibodies grew over time and likely contributed to reduced COVID-19 severity in the latter part of the pandemic. COVID-19 continues to drive morbidity and mortality among LTRs;however, the severity of disease is lower with the omicron variant. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Clinical Outcomes of Lung Transplant Recipients with Covid-19 That Received Pre-Exposure Prophylaxis with Tixagevimab-Cilgavimab: A Single Center Experience

Lung transplant recipients (LTRs) are at risk of significant morbidity and mortality due to COVID-19. The neutralizing antibody response to vaccination among LTRs is reduced, particularly in those treated with anti-proliferative agents. Tixagevimab-cilgavimab (Tix-Cil) is a SARS-CoV-2 spike protein-directed attachment inhibitor that is authorized under Emergency Use Authorization (EUA) to reduce the risk of COVID-19 in immunocompromised adults. We describe the clinical outcomes of LTRs who contracted COVID-19 despite Tix-Cil therapy. After IRB approval, we conducted a retrospective chart review and used descriptive statistics. Following EUA approval, 203 LTRs received Tix-Cil, and 24 (11.8%) subsequently contracted COVID-19. All 24 had undergone bilateral LT;14 (58.3%) were male;23 (95.8%) were vaccinated;and 23 (95.8%) were ≥6 months out from LT. The median age at COVID-19 diagnosis was 68.6 years, and most (75%) were on a standard 3-drug immunosuppressive regimen with tacrolimus, mycophenolate mofetil, and prednisone. The median time from Tix-Cil to COVID-19 diagnosis was 90.5 days (62.75-118.25). Five LTRs (20.8%) were hospitalized;3 (12.5%) required ICU level of care;and 2 (8.3%) were intubated. Two LTRs (8.3%) died;both were male, >70 years old, vaccinated, >2 years out from LT, and had co-morbidities. Both were treated with corticosteroids and tocilizumab;1 received anti-viral and monoclonal antibody therapy with remdesevir and sotrovimab, respectively. Both were critically ill, and 1 was intubated. LTRs that contracted COVID-19 despite pre-exposure prophylaxis with Tix-Cil had significant rates of hospitalization, critical illness, and mortality. More effective therapies are needed to reduce the risk of COVID-19 in this vulnerable patient population. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Guillain-Barré Syndrome after Mrna-1273 Covid-19 Vaccine Booster in an Immunosuppressed Double Lung Transplant Recipient

Guillain-Barré Syndrome (GBS) is an immune-mediated neurological disorder with an estimated incidence of 1 to 2 per 100,000 person-years. GBS is characterized by progressive and symmetric ascending muscle weakness, areflexia, sensory symptoms, and dysautonomia. Antecedent infection or vaccination may trigger GBS;however, there are few reports of GBS after either mRNA-1273 (Moderna) or mRNA-BNT-162b2 (Pfizer-BioNTech) COVID-19 vaccines (1.21 and 1.05 GBS reports per million doses, respectively). A 2021 analysis of the Vaccine Safety Datalink found no increased risk of GBS after vaccination with either of the vaccines. We report a case of GBS after a third dose of mRNA-1273 in a lung transplant recipient (LTxR). A 38-year-old LTxR on standard 3-drug immunosuppression presented to clinic complaining of back pain 2 weeks after receiving a third dose of mRNA-1273. His pain was treated with analgesics;however, a week later he presented to the Emergency Department (ED) with worsening back pain, myalgias, and lower extremity weakness. Neurology was consulted and he underwent an extensive work-up including screening serologies for vasculitis and myasthenia gravis and blood tests for B12, folate, and creatinine kinase (CK) levels. Viral and bacterial infections were ruled out. A spinal MRI showed no evidence of nerve root enhancement;a lumbar puncture revealed albuminocytologic dissociation with a high protein level of 113 mg/dL and cell count of 1/uL. Autoimmune and paraneoplastic panels as well as oligoclonal bands were negative. He was diagnosed with GBS and completed a 5-day IVIG course which led to transient symptomatic improvement. Four weeks later, he reported to the ED in a wheel chair after multiple falls and an inability to stand or walk. His neurological exam showed symmetric ascending weakness of lower extremities that was worse distally, reduced hand-grip strength, and areflexia. Electromyography showed evidence of acute inflammatory demyelinating polyneuropathy, confirming the GBS diagnosis. An additional 2-day IVIG course and intensive outpatient physical therapy led to neurologic improvement. Although current data does not suggest an increased risk of GBS after mRNA COVID-19 vaccines, GBS should be considered in LTxRs who develop symmetric motor and sensory deficits after vaccination. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Molnupiravir vs Remdesivir for Treatment of Covid-19 in Lung Transplant Recipients

Three SARS-CoV-2-directed anti-viral therapies are currently accessible in the United States: remdesivir (REM), molnupiravir (MOL), and nirmatrelvir+ritonavir. The latter has significant drug-drug interactions and is typically not used in lung transplant recipients (LTRs). We compared the efficacy between early REM and MOL treatment of LTRs with COVID-19. LTRs who contracted COVID-19 between 3/2020 and 8/2022 were identified. LTRs with COVID-19 that were well enough to remain outpatient were treated with either REM or MOL, depending on drug availability;REM became available in 10/2020 and MOL in 12/2021. The primary outcome was hospitalization and the secondary outcome was mortality. The analysis was adjusted for SARS-CoV-2 strain, vaccination status, pre-exposure prophylaxis with tixagevimab-cilgavimab, and COVID-19 therapies, eg, monoclonal antibodies and modification of anti-proliferative agent. Of 195 LTRs that developed COVID-19 during the study period, 54 were included and divided into groups: REM (n=25) or MOL (n=29). The baseline characteristics of the two groups were comparable (Table 1). On unadjusted analysis, LTRs treated with MOL were less likely to be hospitalized, admitted to the ICU, or to die from COVID-19;on adjusted analysis, only reduced likelihood of hospitalization remained statistically significant (p=0.035). One-year survival probability was comparable between the groups, but trended lower among LTRs treated with REM (REM: 64% vs MOL: 93.1%, p=0.081, Figure 1). LTRs with COVID-19 treated with MOL were less likely to be hospitalized due to COVID-19 than those treated with REM. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

PROLONGED COLONIZATION AND COISOLATION OF SARS-COV-2 IN UNVACCINATED RECIPIENTS OF LUNG TRANSPLANTS

SESSION TITLE: Pulmonary Issues in Transplantation Case Report Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: We describe two unvaccinated lung transplant recipients (LTRs) with mild COVID-19 and prolonged SARS-CoV-2 colonization who presented with recrudescence of symptoms due to superinfection. CASE PRESENTATION: Case 1: A 57-year-old LTR (August 2018) presented to the emergency room (ER) in July 2020 with headache, positive SARS-CoV-2 nasopharyngeal swab-PCR result, and elevated D-Dimer. He recovered at home and tested negative for SARS-CoV-2 on day 28. He presented to the ER again in October 2020 with chest pain. At this time, evaluation revealed a positive SARS-CoV-2 nasopharyngeal swab-PCR result, positive SARS-CoV-2 IgG (index 3.41), leukocytosis, and elevated inflammatory markers. Of note, nasopharyngeal swab was also positive for rhinovirus. Imaging showed new mild bibasilar ground-glass opacities. Patient was treated with remdesevir, convalescent plasma, and pulse corticosteroid. His SARS-CoV-2 PCR test was negative on day 3 of the remdesevir regimen;he remains clear of SARS-CoV-2 and rhinovirus to date, with complete clinical and radiologic recovery (Figure 1, Case 1). His immunosuppression was unchanged. Case 2: A 75-year-old LTR (July 2016) with pancytopenia presented for a sick visit in May 2020 with cough and fever. His SARS-CoV-2 nasal wash-PCR test was positive;imaging was unremarkable. He was sent home on pulse corticosteroid and levofloxacin. A week later in June 2020, he presented to the ER with worsening cough. At this time, evaluation revealed positive SARS-CoV-2 IgG (index 7.58), leucopenia, thrombocytopenia, elevated inflammatory markers, and new radiographic bibasilar ground-glass opacities (Figure 1, Case 2). His condition improved with intravenous antibiotics and corticosteroids. He consistently tested positive for SARS-CoV-2 in nasal wash samples for 3 months, with the first negative test in September 2020. He was hospitalized in January 2021 for neutropenic fever, P. Aeruginosa (PsA) infection in bronchoalveolar lavage (BAL), and anti-PsA antibodies in the serum. At this time, he also had SARS-CoV-2 colonization in BAL despite negative PCR results of nasal wash samples. His condition improved with 14 days of antibiotics. He was stable at his last follow-up. DISCUSSION: Both patients had an initial episode of mild COVID-19 pneumonitis, appropriate seroconversion, and prolonged viral colonization in the respiratory tract. Immunosuppression may have predisposed to rhinovirus and PsA superinfection in case 1 and 2, respectively. CONCLUSIONS: A high index of suspicion for superimposed infections in LTRs recovering from COVID-19 is warranted. Reference #1: 1. Hogan JI, Kotton CN. A Call for Caution in the Immunocompromised: Coronavirus Disease 2019 Associated With Mortality in a Vaccinated Lung Transplant Recipient. Open Forum Infect Dis. 2021 Nov 10;8(12):ofab557. DISCLOSURES: No relevant relationships by Hesham Abdelrazek No relevant relationships by Ashwini Arjuna No relevant relationships by Bhuvin Buddhdev No relevant relationships by Deepika Razia No relevant relationships by Rajat Walia, value=Honoraria Removed 04/04/2022 by Rajat Walia No relevant relationships by Rajat Walia, value=Honoraria Removed 04/04/2022 by Rajat Walia No relevant relationships by Rajat Walia, value=Honoraria Removed 04/04/2022 by Rajat Walia No relevant relationships by Rajat Walia, value=Honoraria Removed 04/04/2022 by Rajat Walia No relevant relationships by Rajat Walia, value=Honoraria Removed 04/04/2022 by Rajat Walia

Sustainability of Industry 6.0 in Global Perspective: Benefits and Challenges

In the present area, the outbreak of COVID-19, customer behavior have been seen toward their individual specific need, which encourages advanced-manufacturing industries to provide mass personalization of goods and services. The Covid-19 crises bring opportunities for industries and service providers to enhance their capability for a fault-free environment, zero failure, anti-fragile, and improve production capacity. The present paper provides an overview of the sustainability of Industry 6.0 in a global perspective with vision, objective, and transformation of Industrial Revolutions. The sole aim of industry 6.0 is to seizure the new technologies, which can be applied worldwide and deliver wealth, prosperity away from the job and provide growth to nations across all planetary boundaries. This revolution would promote living harmony with nature, support the principle of sustainability where technology would not be a thing, and promote the human virtual digital twin where all can simultaneously see physical goods and virtual product information.

Quality and Regulation Standards for Ventilator as Medical Devices in India

The Drugs & Cosmetic act is meant to regularize safety & quality of medical devices, which is applied to all medical devices, implemented from 1st April 2020. Earlier 37 medical devices were regulated/ notified in India. The present study focuses on the devices which require regulations but still lack the quality check points for scrutiny from Central Drug standard control organization (CDSCO), Delhi. Furthermore, it aims to provide quality checklist for two upcoming devices (Ventilator) which is neither categorized nor regulated by Central Drug standard control organization, Delhi. Since the medical devices aid in diagnosing, treatment and palliative care, it is essential to check the quality such that it matches with the International standards. Post covid-19 outbreak ventilators have come under surveillance and notified as medical devices. The present study monitors all parameters for regulation of the ventilator. The survey based quality & regulation standards for ventilator as medical devices has been incorporated in this study.

Progressive Multifocal Leukoencephalopathy Presenting as Expressive Aphasia in a Lung Transplant Recipient

Introduction: Progressive multifocal leukoencephalopathy (PML) is a demyelinating brain disease caused by reactivation of JC virus in immunocompromised patients. PML typically manifests with subacute neurologic deficits including altered mental status, motor deficits, limb ataxia, gait ataxia, and visual symptoms. We report an atypical presentation of PML in a lung transplant recipient (LTR). Case Report: A 71-year-old LTR received rituximab induction followed by a combination of mycophenolate mofetil, tacrolimus, and prednisone. He had a single episode of minimal acute cellular rejection early after LT, but never required significantly augmented immunosuppression. Notably, he had mild leukopenia throughout his post-LT course (WBC count 3-4 thousand/µL), and he had no response to 4 doses of the Pfizer SARS-CoV-2 vaccine, suggesting advanced immunosuppression. At 14 months after LT, the patient reported progressive anomia and aphasia, but no other neurologic deficits. MRI showed an abnormal increased T2/FLAIR signal in the left posterior parieto-occipital subcortical white matter, involving subcortical U fibers, characteristic of PML (Figure A, C). Serum JC virus PCR showed low-level viremia, but CSF from 2 lumbar punctures was PCR negative. Thus, he was diagnosed with possible PML, and immunosuppression was narrowed to a combination of tacrolimus (goal trough 4-6) and prednisone, 5 mg daily. Despite reduced immunosuppression, a repeat MRI 2 months after the initial diagnosis showed worsening PML (Figure B, D) and his symptoms progressed to severe anomia, aphasia, and cortical blindness, but still no motor deficits. PML is a rare, albeit well described, complication of LT, but presentation with only anomia and aphasia is unusual. Without CSF viral isolation, a definitive diagnosis requires brain tissue;however, MRI changes involving subcortical U fibers in the parieto-occipital area are highly characteristic. Early recognition allows for expeditious management.

A CASE OF ERDHEIM-CHESTER DISEASE IDENTIFIED SIX MONTHS AFTER LUNG TRANSPLANT

TYPE: Case Report TOPIC: Transplantation INTRODUCTION: Erdheim-Chester disease is a rare type of non-Langerhans histiocytosis that can manifest with bone pain, marked elevation of alkaline phosphatase, and osteosclerotic lesions of long bones. CASE PRESENTATION: A 37-year-old female, bilateral lung transplant recipient (10/2020) with a history of post-COVID-19 acute respiratory distress syndrome, complicated by acute cellular rejection, antibody-mediated rejection, and refractory gastroparesis, was found to have Erdheim-Chester disease in the work-up of infiltrative pattern of liver enzymes at 6-months after transplant. DISCUSSION: The early postoperative course was complicated as described above;during her most recent hospital admission, she had an isolated elevation of alkaline phosphatase (208 U/L) with no obvious gastrointestinal symptoms, excluding gastroesophageal reflux or other hepatobiliary pathology. Over the course of one week, her alkaline phosphatase increased to 928 U/L, and the patient described a new onset, mild and non-specific lower tibial pain. A gamma-glutamyl transferase was elevated, necessitating a skeletal work-up. A bone scan and lower extremity radiographs both showed subtle, patchy, intramedullary sclerosis and cortical thickening in the right lower extremity. Together, her bone pain, elevated alkaline phosphatase, and radiologic features were consistent with Erdheim-Chester disease. Although a bone biopsy was warranted, given her guarded prognosis, this intervention was not pursued. CONCLUSIONS: Erdheim-Chester disease generally requires careful observation for disease progression. Unfortunately, in a lung transplant recipient with worsening allograft function and repeated hospitalization, the prognosis is poor. DISCLOSURE: Nothing to declare. KEYWORD: Erdheim-Chester Disease

EXCELLENT ALLOGRAFT RECOVERY DESPITE PROLONGED SARS-COV-2 SHEDDING AFTER REDUCTION OF IMMUNOSUPPRESSION IN LUNG TRANSPLANT RECIPIENT

TOPIC: Transplantation TYPE: Medical Student/Resident Case Reports INTRODUCTION: Immunosuppressed lung transplant recipients (LTxRs) are predisposed to severe SARS-CoV-2 disease, impaired virus clearance, and increased mortality. Successful recovery from SARS-CoV-2 infection after reduction of immunosuppression (IS) has been reported in kidney and heart transplant recipients [1,2]. We report a case of favorable allograft outcome after reduction of IS in an LTxR with SARS-CoV-2 pneumonia despite prolonged virus shedding. CASE PRESENTATION: A 58-year-old bilateral LTx recipient (July 2020) with blood type A+ was admitted for a positive SARS-CoV-2 RT-PCR result from a nasal wash on July 31, 2020 (day 1). He exhibited fever, increasing shortness of breath, a productive cough, and bilateral radiographic infiltrates, but normal oxygen saturation on room air and stable pulmonary function tests (FVC and FEV1 at 3.17 and 2.65 liters, respectively). Shortly after hospitalization, his dyspnea and oxygen requirement increased (3 LPM) and inflammatory markers were elevated (nadirs of lymphocyte 2.7 thousand/µL and platelet 158 thousand/µL;peaks of D-dimer 260 ng/mL, CRP 75.2 mg/L, ferritin 219 ng/mL, pro-calcitonin 0.22 ng/mL, and LDH 215 U/L). Imaging favored progression of SARS-CoV-2 pneumonia. DSA against DP1 measured 1350 MFI, and immunoglobulin therapy was started. The patient was managed with intravenous corticosteroid pulse, Remdesivir, and convalescent plasma along with appropriate antibiotic therapy due to additional concern for superimposed infection. On day 8 of illness onset, the patient no longer had clinical symptoms, and he was discharged on room air and steroid taper. On outpatient follow-up, the patients' endurance had increased;PFTs improved (FVC and FEV1 at 3.9 and 3.39 L, respectively);DSAs were reassuring;and radiographic changes had resolved by day 42 (Figure 1: serial chest imaging from illness onset to day 42). Of note, the ImmuKnow result at illness onset was 64 ng/mL, and mycophenolate (MMF) was reduced to 500 mg BID, after which the ImmuKnow result increased to 560 ng/mL. Seroconversion for SARS-CoV-2 IgG was mounted on day 26 (index 1.56), and MMF was resumed to baseline dose of 750 mg BID on day 35. Remarkably, prolonged viral shedding in nasal wash was noted with the first negative RT-PCR for SARS-CoV-2 on day 47. DISCUSSION: Our patient had excellent recovery with intact graft function despite prolonged virus persistence. Although an immunosuppressed state may have predisposed our patient to bacterial superinfection, reduction of MMF possibly augmented the antiviral response. Despite reduced IS, seroconversion and virus clearance may have been impacted. CONCLUSIONS: Immunosuppressed LTxRs with SARS-CoV-2 pneumonia may demonstrate prolonged viral shedding. Reduction in IS may facilitate allograft recovery despite delayed PCR conversion. Isolation measures should be considered due to possible prolonged infectivity. REFERENCE #1: Li F, Cai J, Dong N. First cases of COVID-19 in heart transplantation from China. J Heart Lung Transplant. 2020 May;39(5):496-497. REFERENCE #2: Zhu L, Xu X, Ma K, Yang J, Guan H, Chen S, Chen Z, Chen G. Successful recovery of COVID-19 pneumonia in a renal transplant recipient with long-term immunosuppression. Am J Transplant. 2020 Jul;20(7):1859-1863. DISCLOSURES: No relevant relationships by Ashwini Arjuna, source=Web Response No relevant relationships by Ross Bremner, source=Admin input No relevant relationships by Ericka Charley, source=Web Response No relevant relationships by Hesham Mohamed, source=Web Response No relevant relationships by Kristine Nally, source=Web Response No relevant relationships by Ashraf Omar, source=Admin input No relevant relationships by Deepika Razia, source=Web Response Speaker/Speaker's Bureau relationship with Genentech Please note: $5001 - $20000 by Rajat Walia, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Boehringer Ingelheim Please note: $5001 - $20000 by Rajat Walia, source=Web Response, value=H noraria Speaker/Speaker's Bureau relationship with Grifols Please note: $5001 - $20000 by Rajat Walia, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Shire Please note: $1001 - $5000 by Rajat Walia, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Astellas Please note: $5001 - $20000 by Rajat Walia, source=Web Response, value=Honoraria

Improving material quality management and manufacturing organizations system through Industry 4.0 technologies

In these changing times, Industry 4.0 technologies are being adopted in many parts of the world. These technologies are used to develop smart materials, smart factories, smart logistics, smart warehousing and smart supply chains. In the business aspect, it has the potential to solve complex manufacturing problems. This paper provides a thorough study of various Industry 4.0 technologies for improving the material quality and manufacturing systems. We have listed out various available technologies, their characteristics, and benefits of effective management in the upcoming industries. Digital technologies help companies optimize their material wastage and inventory which ends up in cost reductions. With remote collaboration, on-site and off-site employees can easily collaborate as and when needed. These technologies ultimately reduce communication gaps and help them stay up to date with the information. Smart predictive analysis will help to properly monitor the equipment in the industries using Industry 4.0 technologies. Faults in materials can be detected and resolved at an early stage. Further, this provides transparency in the systems and processes and fulfills the required expectation of the customer. (c) 2021 Elsevier Ltd. All rights reserved. Second International Conference on Aspects of Materials Science and Engineering (ICAMSE 2021).