ABSTRACT
Background: The transplant patients should be considered a main high-risk population during the COVID-19 outbreak due to the use of immunosuppressive regimens and comorbidities. Objective: This study aimed to evaluate the possibility of COVID-19 transmission by liver transplantation from a donor with a late complication of COVID-19 to the recipients. Methods: This descriptive study was conducted on all the recipients of liver transplantation who had an acute liver failure or were the models for the End-Stage Liver Disease (MELD) higher than 20. Results: In general, 36 liver transplantation was performed during the study period. Out of these patients, only 14 cases (deceased donors) had hemorrhagic cerebrovascular accidents, and other donors died of trauma (n=7) and anoxia (n=15). All patients showed negative results for polymerase chain reaction (PCR) (two negative 24 h PCR), whereas their high-resolution computed tomography (HRCT) test revealed that they had previously lung involvement with COVID-19 as the late complication of the disease. Conclusion: This study supports the safety of continuing donation and transplant process during the outbreak even the transplant donor be infected previously with the COVID-19, which is reinforced by other similar pieces of evidence.
ABSTRACT
Background: It seems that transplant recipients are at high risk for severe COVID-19, especially in the presence of comorbidities and immunosuppression. This study aimed to determine the effects of previous treatment with immunosuppressants and received dosage and the risk of COVID-19 severity and mortality in liver transplant recipients in various post-transplantation phases in the Iranian population. Methods: This was a cross-sectional study conducted among 24 patients in the post liver transplant course, who were referred to two transplant centers (Imam Reza and Montaseriyeh hospitals) affiliated to Mashhad University of Medical Sciences, Mashhad, Iran, during 2020-2021. The demographic and clinical characteristics of the patients were recorded in a checklist, and the relation-ships between various variables were analyzed. Results: The majority of the post liver transplant patients (96%) were in the late phase of post-trans-plantation, and 8.3% of the cases expired. COVID-19 severity and mortality did not show a significant relationship with previous treatment with immunosuppressants and received dosage (P>0.05). In addition, there was no relationship between the symptoms of COVID-19 and immunosuppres-sant dosages, except for a headache. No significant correlation was found between immunosuppres-sants dosage and laboratory findings, and only prednisolone dosage was found to be correlated with heart rate (r=-0.62, P=0.03), BUN (r=-0.84, P=0.002), and D-dimer (r=-0.72, P=0.01). Conclusion: Severe SARS-CoV-2 infection was reported in the majority of liver transplant recipi-ents. The severity of COVID-19 was not related to previous treatment with immunosuppressants and received dosage.
ABSTRACT
Aim: This study aimed to evaluate the prevalence of Coronavirus Disease 2019 (COVID-19) positive cases meeting clinical brain death criteria;moreover, it was attempted to as-sess the uncommon manifestations of the infection in this study. Materials and Methods: This retrospective observational study was conducted on all brain-dead patients who were referred to the emergency department of hospitals in Mashhad, Iran, from Fe-bruary to October 2020. The demographic characteristics, clinical information, and laboratory data were collected and recorded in a researcher-made checklist. Results: In general, 70 patients were entered in this study. The PCR test result was positive for COVID-19 in 54% of the patients, and syncope was reported in 16.1% of the cases (n=10). Further-more, the majority of the patients (52.9%) showed Central Nervous System (CNS) hemorrhagic manifestations. A comparison was made between the patients with positive and negative PCR test result in terms of syncope;accordingly, there was a significant difference between them in this re-gard (χ2=4.5;P=0.03). The CNS hemorrhagic manifestations were significantly higher in patients with positive PCR compared to those with negative PCR (χ2=4.57, P=0.03). Moreover, the grand glass opacity and pleural effusion were the most common findings of the chest computed tomogra-phy in brain-dead patients with COVID-19. Conclusion: Due to the high prevalence of COVID-19 among brain-dead patients, it seems that syncope attack should be regarded as one of the possible symptoms of COVID-19. Moreover, syn-cope as a result of COVID-19 may itself cause traumatic events. It is worth mentioning that CNS hemorrhagic manifestations have been reported in more than half of the patients with brain death.
ABSTRACT
Background: Transplant recipients are at high risk for severe Coronavirus disease-2019 (COVID-19). Transplant recipients are immune-compromised individuals at high risk for severe infection. This study aimed to compare the presentations and outcomes of liver and kidney transplant recipients who were infected with COVID-19 in the Iranian population. Methods: This cross-sectional study was conducted at Imam Reza and Montaserieh Hospitals affiliated with Mashhad University of Medical Sciences, Mashhad, Iran, between 2020 and 2021. In general, 52 patients were selected and divided into two groups of the kidney (n=28) and liver (n=24) transplantation. Two groups were compared in terms of demographic characteristics and clinical findings. Results: Of the 52 patients, severe COVID-19 infection was reported in 61% of the patients. There was no significant difference between the two groups in terms of symptoms, except for cough (chi(2)=8.09;P=0.004), clinical condition, and laboratory symptoms, except for creatinine (Z=14;P<0.005), alkaline phosphatase (Z=4.55;P=0.03), total bilirubin (Z=8.93;P=0.03), and partial thromboplastin time (Z=5.97;P=0.01). There was no relationship between the outcome and the use of immunosuppressive medications (P>0.05). All patients with kidney transplantation survived, while two cases in the liver transplantation group failed to survive (chi(2)=2.42;P=0.11). Conclusion: The mortality rate was higher in the liver transplant recipients, compared to the patients who underwent kidney transplantation.