The Prevalence of Viral Pathogens among Bats in Kazakhstan.

Bats carry thousands of viruses from 28 different families. To determine the presence of various pathogens in bat populations in Kazakhstan, 1149 samples (393 oropharyngeal swabs, 349 brain samples, 407 guano) were collected. The samples were collected from four species of bats (Vespertilio murinus, Nyctalus noctula, Myotis blythii, Eptesicus serotinus) in nine regions. The Coronavirus RNA was found in 38 (4.75%) samples, and the rabies virus in 27 (7.74%) samples from bats. Coronaviruses and the rabies virus were found in bats in six out of nine studied areas. The RNAs of SARS-CoV-2, MERS, TBE, CCHF, WNF, influenza A viruses were not detected in the bat samples. The phylogeny of the RdRp gene of 12 samples made it possible to classify them as alphacoronaviruses and divide them into two groups. The main group (n = 11) was closely related to bat coronaviruses from Ghana, Zimbabwe and Kenya. The second group (n = 1) was closely related to viruses previously isolated in the south of Kazakhstan. The phylogeny of the N gene sequence from a bat from west Kazakhstan revealed its close relationship with isolates from the Cosmopolitan group of rabies viruses (Central Asia). These results highlight the need for a continuous monitoring of volatile populations to improve the surveillance and detection of infectious diseases.

Clinical Outcomes in a Large Transplant Cohort Hospitalized with COVID-19: Mycophenolate Mofetil (MMF) Utilization and Mortality Trends

Purpose: To characterize demographics, treatment patterns, and outcomes among 3,998 transplant patients hospitalized for COVID-19 over 16 months of the pandemic (May '20-Aug '21). Method(s): Adult patients in a transplant cohort (TC) and non-transplant cohort (NTC) hospitalized with COVID-19 (ICD-10: U07.1) were compared in the Premier Healthcare Database from May '20-Aug '21. Baseline measures in first two days, demographics, comorbidity, COVID-19 treatments and immunosuppressants were analyzed. Outcomes included mortality (discharge status expired or hospice) and hospital and ICU LOS. Result(s): 3,998 TC patients were hospitalized for COVID-19 in 587 US hospitals. Compared to NTC, TC were younger (61 vs 64 yrs;p<.0001), less likely to be white (59% vs 67%;p<.0001), obese (24% vs 33%;p<.0001) or have COPD (17% vs 24%;p<.0001). TC had higher rates hypertension (84% vs 69%;p<.0001), renal disease (80% vs 22%, p<.0001), diabetes (48% vs 29%;p<.0001) and chronic heart failure (23% vs 18%;p<.0001). During hospitalization, a lower proportion of TC needed any oxygen therapy compared to NTC (p<.05). Compared to NTC, fewer TC received remdesivir (RDV) (44% vs 48%;p<.0001), but more received corticosteroids (87% vs 78%;p<.0001), anticoagulants (44% vs 29%;p<.0001) and convalescent plasma (18% vs 16%;p=0.007). In TC, 44% received MMF, 73% calcineurin inhibitors and 5% mTOR. Use of MMF did not change over time (43% May-Jul 2020;43% Aug- Dec 2020;45% 2021). TC had higher ICU admission rates (31% vs 28%;p.001), but similar hospital LOS and ICU LOS compared to NTC. All-cause mortality in NTC (15% overall;16% May-Jul 2020;16% Aug-Dec 2020;14% 2021) was not significantly different than TC over time (16% overall;13% May-Jul 2020;16% Aug-Dec 2020;16% 2021). Conclusion(s): Very few large studies have assessed COVID-19 management in transplant patients over time. All-cause mortality was comparable in both cohorts despite TC immunosuppression. RDV use was lower in TC. Uncertainty around MMF use in COVID-19 patients did not impact reported use of MMF. Further analyses are needed to evaluate confounding factors (medication sequence, time since transplant, disease severity) and impact of external factors such as earlier testing and treatment for COVID-19, vaccination, and new variants. (Table Presented).

Prospective Analysis of the Impact of Impella 5.5 Devices on HLA Antibody Development in Transplant Recipients

Purpose: Little is known about the development of Human Leukocyte Antigen antibodies with the use of the new Impella 5.5 temporary mechanical circulatory assist device. Method(s): The prevalence and strength of HLA Class I and II antibodies were assessed prospectively from 6 patients with the Impella 5.5 and 10 control patients with no device support. Single antigen beads (One Lambda) were used to detect HLA antibodies in serum samples pre- and post-implantation of the device up to the time of heart transplantation. 6-month analysis for de novo HLA antibodies, rejection, rehospitalization and deaths were analyzed. Result(s): Baseline characteristics are shown in table 1A. 3/10 and 2/6 patients had pre-transplant HLA antibodies in the control and Impella groups, respectively. Additionally cross match results are shown in Table 1B. There was no increase in the prevalence of HLA antibodies detected post-transplant. None of the patients were admitted for concern of rejection, nor required outpatient optimization of immunosuppression. In the control group, 3 patients were hospitalized within 6 months post-transplant for non-rejection (COVID infection, pericardial effusion and right ventricular failure). There were no re-admissions within the Impella group. There was one death in the Impella group prior to discharge at index admission for transplant due to CMV viremia and stenotophomonas maltophilia infection post-transplant. There were no deaths in the control group. (Table 1C). Conclusion(s): The use of the new Impella 5.5 MCS assist device does not appear to increase the risk of development of de novo HLA antibodies nor appear to increase the risk of allograft rejection. Larger studies are needed to validate these preliminary findings.

Management of Patients With Pulmonary Hypertension in COVID-19 Pandemic

The new coronavirus (COVID-19) epidemic caused by SARS-CoV-2 has emerged as perhaps the biggest medical problem of our century. Although COVID-19 mainly affects the lungs, it also affects many organs, especially the cardiovascular system. Pulmonary hypertension (PH) is a pulmonary vascular disease described by pulmonary arterial vasoconstriction and remodeling, which may lead to an increased pulmonary artery pressure with varying clinical course and severity depending on the etiology and eventually to right heart failure. Because of associated comorbidities, patients with PH are likely to face a potential risk of severe complications and mortality and unfortunately, they may have worse outcomes than other patients. The COVID-19 pandemic has brought us new and different challenges in the follow-up and treatment processes of patients with PH. For patients admitting to the hospital, it is important to balance the risk of exposure to COVID-19 with ongoing care and treatment services. However, the COVID-19 outbreak has brought serious challenges to PH centers to weigh the risks and benefits of diagnostic research, including potential exposure to COVID-19, and the timing of initiation of PH-specific treatment in high-risk patients. In this article, the management of PH patients during the COVID-19 pandemic;problems encountered in diagnosis, clinical follow-up and treatment processes;the different difficulties experienced during hospitalizations have been compiled.

Alloimmune Response After SARS-CoV-2 Vaccination in Lung Transplant

The effect of SARS-CoV-2 vaccination on de novo donor specific antibodies (dn DSA) in lung transplant recipients (LTRs) is unknown. We reviewed dn DSA results following SARS-CoV-2 vaccination in LTRs based on SARS-CoV-2 IgG response. LTRs were tested for SARS-COV-2 Multi-target IgG at 3 and 6 months post-vaccination. LTRs who received at least 1 dose of SARS-CoV-2 vaccine between 12/01/2020 to 07/01/2021 were included in this retrospective review. We compared patients based on anti-spike (S-IgG) results. We reviewed 55 LTR charts with S-IgG results. Only 24 (44%) developed S-IgG by 6 months after vaccination. Differences between S-IgG positive and negative groups are shown in the table. Those with positive S-IgG were further from transplant, had lower mycophenolate doses, more likely to have had COVID infection pre-vaccination, and had lower rates of hypogammaglobulinemia. Only 3 patients (5.5%) developed dn DSA after vaccination;all were S-IgG positive. One had history of antibody mediated rejection (AMR), while another was initially negative for dn DSA at 6 weeks post-vaccination, but turned positive at 7 months (low level Class II DSA). One patient who had prior DSA developed clinical rejection (AMR) with Class II dn DSA (DR7) and significant rise in prior DSA (DR53, DQ2) to >20,000 MFI at 6 months (negative at 3 months) post-vaccine in the setting of new viral infection. Another patient was excluded from this study as he died of AMR and dn Class II DSA (DQ8 > 10,000 MFI, DQ6, DR4 within 5 days of dose) 2 months after his first Pfizer/BioNTech dose, but before 3 month S-IgG testing. In our cohort, dn DSA after SARS-CoV-2 vaccination was uncommon but observed in patients who developed S-IgG response. The single AMR case occurred late and may be related to infection. In the excluded patient with acute AMR early after vaccine, correlation to S-IgG is unknown as the patient did not survive to 3 months. Further studies are needed to determine the impact of additional vaccine doses and long-term outcomes and immune responses. [ 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 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 . (Copyright applies to all s.)