Biobehavioral Implications of Covid-19 for Transplantation and Cellular Therapy Recipients

Jennifer M. Knight, Mallory R. Taylor, Kelly E. Rentscher, Elisabeth C. Henley, Hannah A. Uttley, Ashley M. Nelson, Lucie M. Turcotte, Natalie S. McAndrew, Hermioni L. Amonoo, Lathika Mohanraj, Debra Lynch Kelly, Erin S. Costanzo

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations


A growing body of literature has emphasized the importance of biobehavioral processes – defined as the interaction of behavior, psychology, socioenvironmental factors, and biological processes – for clinical outcomes among transplantation and cellular therapy (TCT) patients. TCT recipients are especially vulnerable to distress associated with pandemic conditions and represent a notably immunocompromised group at greater risk for SARS-CoV-2 infection with substantially worse outcomes. The summation of both the immunologic and psychologic vulnerability of TCT patients renders them particularly susceptible to adverse biobehavioral sequelae associated with the Covid-19 pandemic. Stress and adverse psychosocial factors alter neural and endocrine pathways through sympathetic nervous system and hypothalamic-pituitary-adrenal axis signaling that ultimately affect gene regulation in immune cells. Reciprocally, global inflammation and immune dysregulation related to TCT contribute to dysregulation of neuroendocrine and central nervous system function, resulting in the symptom profile of depression, fatigue, sleep disturbance, and cognitive dysfunction. In this article, we draw upon literature on immunology, psychology, neuroscience, hematology and oncology, Covid-19 pathophysiology, and TCT processes to discuss how they may intersect to influence TCT outcomes, with the goal of providing an overview of the significance of biobehavioral factors in understanding the relationship between Covid-19 and TCT, now and for the future. We discuss the roles of depression, anxiety, fatigue, sleep, social isolation and loneliness, and neurocognitive impairment, as well as specific implications for sub-populations of interest, including pediatrics, caregivers, and TCT donors. Finally, we address protective psychological processes that may optimize biobehavioral outcomes affected by Covid-19.

Original languageEnglish (US)
Article number877558
JournalFrontiers in immunology
StatePublished - Jul 5 2022

Bibliographical note

Funding Information:
We thank the Steering Committee members of the American Society for Transplantation and Cellular Therapy Biobehavioral Research Special Interest Group for their review and approval of this manuscript.

Publisher Copyright:
Copyright © 2022 Knight, Taylor, Rentscher, Henley, Uttley, Nelson, Turcotte, McAndrew, Amonoo, Mohanraj, Kelly and Costanzo.


  • Covid-19
  • biobehavioral
  • outcomes
  • stress
  • transplantation and cellular therapy


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