Pre-Transplant Vaccine Induced SARS-CoV-2 Antibodies Decrease Following Induction Therapy for Kidney Transplantation

Purpose: Kidney transplant recipients (KT) and wait-listed individuals exhibit an impaired response to vaccinations. There is currently no data on the impact of induction immunosuppression followed by standard immunosuppression on the antibody (Ab) dynamics of wait-listed individuals undergoing KT. Here, we assess the SARS-CoV-2 antibody dynamics prior and one month following transplantation Methods: Previously immunized wait-listed patients (2 mRNA vaccine doses: mRNA-1273 or BNT162b2 at least 14 days prior to KT) who subsequently underwent KT were included. Serum was collected within 24 hours prior to transplantation and 3-4 weeks following transplantation. ELISAs measuring anti-S and anti-RBD titers on pre- and post-transplant samples were performed. Serial dilutions of patient samples were prepared and AUC were calculated for paired samples from each participant. Paired samples were run simultaneously to reduce the effect of interplate variability. Wilcoxon and Mann-Whitney test were used to compare paired and unpaired samples, respectively Results: 35 patients were included (12 LKT/23 DDKT). 34 patients received induction with ATG, 1 with Basiliximab. Standard immunosuppression consisted of prednisone (2-week taper), mycophenolate and tacrolimus. 61% received mRNA- 1273 and 39% BNT162b2. We found no difference in Abs between vaccines. Anti- RBD Ab and anti-S Ab had a significant decline following KT at the one-month endpoint (anti-RBD Pre-KT: 1581 vs Post-KT: 473 p<0.0001 anti-S Ab Pre-KT: 4058 vs 1739 p<0.0001). 29 wait-listed patients were on dialysis and had lower pre-transplant Abs (anti-RBD dialysis: 1508 vs no dialysis: 3790 p=0.5. Anti-S Ab dialysis: 3841 vs no dialysis: 10058 p=0.17). The differences remained post-KT. 3 patients developed COVID-19 following transplantation (median: 123 days). They had lower pre- and post-transplant Ab (post-transplant anti-RBD COVID-19: 181 vs no COVID-19: 486 p=0.3, anti-S COVID-19: 1672 vs no COVID-19: 613 vs no COVID-19: 1801 p=0.4) Conclusion(s): Induction immunosuppression followed by standard immunosuppression led to a significant decrease of both anti-S and anti-RBD ab in KT recipients. Waitlisted individuals on dialysis had lower Abs both pre-and post-transplant. Patients who developed post KT COVID-19 had lower Ab levels. Our data suggests that immediate post-transplant KTs may require additional vaccinations against COVID-19.

Acquired infections in intensive care unit (ICU) COVID-19 patients

Introduction: Patients with COVID-19 admitted to the ICU are at high risk of developing infectious complications during their ICU stay. Data on acquired(AI) in Portuguese critical COVID-19 patients are scarce. The aim of this study was to investigate the characteristics and risk factors for AI in critical patients with COVID-19 pneumonia admitted to the ICU. Methods: Retrospective cohort of patients with COVID-19 pneumonia admitted to an ICU in a tertiary hospital, between September 2020 and June 2021. AI considered were ventilator-associated pneumonia (VAP) or tracheobronchitis (VAT), bacteremia, CVC associated infections, urinary tract infections and soft skin tissue infections. Baseline characteristics, 3-months previous antibiotic (ATB) exposure, ATB treatment at ICU-admission and clinical management of COVID-19 pneumonia were analyzed. Results: Of the 159 patients included, with a median (IQR) age of 66 (57-72) and 63.5% males, 14 (8.8%) had no known comorbidities. A total of 63 patients(39.6%) developed AI: 45(71.4%) VAP, 20(33.3%) VAT, 28 (45.2%) UTI, 6 (9.5%) CVC associated infections and 3(4.8%) soft skin tissue infections. In univariate analysis, both SOFA score at admission (p < 0.001), acute cardiovascular (p = 0.003) and neurologic (p = 0.006) disfunction at ICU admission were associated with the development of AI. AI were also correlated to need of tracheostomy(p < 0.001), development of delirium (p < 0.001) or shock (p < 0.001);and with longer ICU and in-hospital stay (p < 0.001) and ICU and hospital mortality (p = 0.011 and p = 0.011, respectively). None of the COVID-19 pharmacologic treatments considered (remdesivir, steroids and tocilizumab), neither different regimens of ATB therapy at ICU admission were significantly associated with AI. Conclusions: In this cohort, almost 40% of the patients developed AI, that was associated with 4 times higher hazard of needing mechanical ventilation and higher rate of adverse events such as delirium, shock during in-ICU stay and longer length of ICU and in-hospital stay.

Characteristics and outcomes of critical COVID patients in the intensive care unit

Introduction: This study aimed to determine the mortality and morbidity of COVID-19 patients in an intensive care unit (ICU) until hospital discharge, and explore the factors that influence in-ICU and in-hospital mortality rates. Methods: Single center retrospective cohort regarding COVID-19 critical patients in a tertiary hospital ICU, from September/20 to June/21. Demographic data, clinical characteristics, admission SOFA score, frailty score (FS) and clinical management were analyzed. Results: We included 159 consecutive COVID-19 critical patients. The median (IQR) age was 66(57-72);101(63.5%) were male. A total of 126 (79.2%) patients received hospital discharge, ICU-mortality rate was 18.9%(30 deaths). The median (IQR) ICU length of stay was 12 days (6-20) and in-hospital stay was 21(13-35), and no significant differences were found in ICU and in-hospital length of stay between survivors and non-survivors. At admission to the ICU total SOFA score was 4(3-7). In univariate analysis, increased age, higher admission SOFA score, acute kidney injury and acute neurologic disfunction at admission were significantly associated with increased hazard of mortality. The need for mechanical ventilation were associated with higher risk of ICU and in-hospital mortality. Previous comorbidities (hypertension, diabetes, obesity, heart failure, COPD, renal, hepatic, oncologic or immunosuppression) or the FS were not significantly associated with in-hospital mortality. None of the COVID-19 pharmacologic treatments (remdesivir, steroids and tocilizumab) were significantly associated with in-hospital mortality. In a multivariable analysis with in-hospital death as the dependent variable, a 10 year increase in age was associated with a mortality OR of 2.9 (95 CI:1.5-5.5)( p = 0.002) and the development of shock during ICU stay was associated with a mortality OR of 8.8 (95 CI:1.5 to 53.3). Conclusions: In this cohort, only age and the development of shock during ICU stay were independently associated with higher risk of inhospital death.

Criteria and practice patterns for accepting living donors with prior COVID-19: A national survey

Purpose: A critical question facing transplant programs is if, when and how to safely accept living kidney donors (LKD) who have a history and recovered from COVID-19 Infection. The purpose of the study is to understand current practices related to accepting living donors for donation who have recovered from COVID-19. Methods: We surveyed US transplant programs from September 3, 2020 through November 3, 2020 by e-mail and postings to professional society list-serves. Center level as well individual opinion based responses were analyzed. Results: A total of 174 US respondents from 115 unique centers responded, representing 59% of US Living Donor Programs and 72.4% of 2019 and 71.9% of 2020 LKD volume (as of October 31, 2020). Respondent Roles included Nephrologist (53.4%);Surgeon (19.5%);Infectious Disease (11.5%);Coordinator (9.8%). Overall during the survey period, 48.6% of responding centers had received inquiries from such LKDs, while 44.3% were currently evaluating such donors. A total of 98 donors were reported to be in the evaluation phase, while 27.8% centers had approved a total of 42 such donors to proceed with donation. Conclusions: Selection practices and criteria for LKD who have recovered from COVID-19 are variable. Ongoing research and consensus building are needed to guide optimal practices to ensure the safety of accepting such donors.

PET–Health Interprofessionality CER II: Group narratives on everyday work activities in front of the changes driven by Covid-19

This article recounts the experiences of a group of students, preceptors and tutors participating in the Education through Work for Health Program- PET-Health Interprofessionality at the Federal University of Sao Paulo in the context of the Covid-19 pandemic. We constructed collective narratives based on the students’, preceptors’ and tutors’ accounts. The narratives reveal personal difficulties, distress caused by social distancing, changes at work and the university, and concern with offering new forms of care to service users. The findings demonstrate that online activities demand much more from the actors involved, prompting them to reflect on interprofessional education. Using narratives, we recount what happens in a context of ruptures and how the group became stronger and reinvented care strategies. By narrating touching group experiences as a group, these experiences become collective and share a way of experiencing the world.

PET-Health Interprofessionality CER II: group narratives on everyday work activities in front of the changes driven by Covid-19

This article recounts the experiences of a group of students, preceptors and tutors participating in the Education through Work for Health Program- PET-Health Interprofessionality at the Federal University of Sao Paulo in the context of the Covid-19 pandemic. We constructed collective narratives based on the students', preceptors' and tutors' accounts. The narratives reveal personal difficulties, distress caused by social distancing, changes at work and the university, and concern with offering new forms of care to service users. The findings demonstrate that online activities demand much more from the actors involved, prompting them to reflect on interprofessional education. Using narratives, we recount what happens in a context of ruptures and how the group became stronger and reinvented care strategies. By narrating touching group experiences as a group, these experiences become collective and share a way of experiencing the world.