ABSTRACT
Purpose: Infectious complications are a major cause of mortality and morbidity after kidney transplantation. During the COVID-19 pandemia there were several changes in the management and behavior of patients after transplant. These included measures such as universal masking, social distancing and reinforcing hand hygiene. Our objective was to evaluate if these differences affected the incidence of infections after kidney transplant. Method(s): This is a retrospective cohort study of all kidney transplants performed in our institution from March 2017 to November 2020. We examined the incidence of wound infection, urinary tract infection (UTI), pneumonia, and gastrointestinal (GI) infections. Pediatric and multi-organ transplants were excluded. We used the Fisher test, Chi-squared test of independence and logistic regression models in the analysis. All tests were based on a level of significance of alpha=0.05. Result(s): A total of 185 deceased donor kidney transplant patients were reviewed, 153 before and 54 after the beginning of the COVID-19 pandemic in the United States. The incidence of wound infection, pneumonia and GI infection were similar before and after COVID (Table 1). There was a significant increase in UTI after the COVID pandemic, the main organisms isolated were Klebsiella pneumonia (50%) and E. coli (25%). Overall the presence of UTI and wound infection were significantly related (OR 4.2, p = 0.06). Other clinical variables such as age, BMI, KDPI, EPTS, and the occurrence of delayed graft function were not associated with UTI. COVID infection was present with similar incidence: 12% in patients transplanted before and 14.8% in patients transplanted after the onset of the pandemic. Induction with Thymoglobulin or Basiliximab was not significantly different before and after COVID, and the choice of induction was not associated with the rate of UTI. Conclusion(s): While multiple changes in the management of patients and patient behavior are different before and after the onset of the COVID-19 pandemic, this analysis did not find significant change in the incidence of infections except for UTI in comparative cohorts of kidney transplant recipients. This study did not identify specific factors associated with the increase of UTI in our population. However, in response certain measures were implemented, such as reducing the time to ureteral stent removal and giving 24 hrs of prophylactic antibiotics at the time of stent removal.
ABSTRACT
HLA molecules are key restrictive elements to present intracellular antigens for an effective T-cell response against SARS-CoV-2. HLA alleles vary with respect to their potential to present immunogenic viral epitopes and may therefore determine disease severity. Therefore, we set out to investigate the impact of individual HLA genotypes on the severity of SARS-CoV-2 infections. In August 2020 and July 2021, we performed cross-sectional studies among stem cell donors registered with DKMS in Germany. Volunteers registered for stem cell donation represent a comparable healthy subset of the working age population. Available genetic information was linked to self-reported COVID-19 outcome data. Multivariable regression models were fitted to determine the risk of contracting SARS-CoV-2, severe respiratory tract infection and respiratory hospitalization. More than 200,000 registered donors provided informed consent and participated in the study. Their age ranged from 18 to 61 years. Altogether 16,121 participants donors reported a history of COVID-19. Asymptomatic courses were reported by 1428 participants, mild/moderate symptoms by 10,353 participants, severe respiratory infections by 3913 not requiring hospitalization and respiratory hospitalizations by 427 patients. Notably, we did not observe a heterozygote advantage. The risk for severe infections was not statistically different among individuals with or without homozygosity at HLA-A, -B, -C, -DRB1, -DQB1 and -DPB1. Of 84 HLA-A, -B, -C, -DRB1, -DQB1 and -DPB1 alleles which were prevalent in more than 400 participants only the presence of HLA-B∗39:01 had significant impact on the risk for respiratory hospitalization (OR 2.23, p = 0.01) at a significance level of 1%. These findings suggest that the HLA genotype is no major factor determining COVID-19 severity. It is therefore possible that the relatively large viral genome of 29.8 kb encodes for abundant epitopes to mount T-cell responses not limited by the HLA genotype.
ABSTRACT
Purpose: To determine pooled prevalence of outcomes among hospitalized liver transplant recipients with COVID-19 through meta-analysis. Methods: A database search was completed between Dec1, 2019-Nov15, 2020, as PRISMA guidelines and random-effect analysis performed. Twelve studies, 517 hospitalized liver transplant patients with COVID-19 were included. Results: Common presenting symptoms were fever(71%), cough(62%), dyspnea( 48%), and gastrointestinal symptoms(28%). 77%(95%CI, 61%-93%) transplant were due to cirrhosis. The most prevalent co-morbidities were hypertension(55%), diabetes(45%) and cardiac disease(21%)(Table-1,2). In-hospital mortality was 20%(95%CI, 13%-28%);which arose significantly in ICU group 41% (95%CI, 19%-63%)(P value<0.00)(Fig1:A,B). Further, analysis showed significantly increased mortality-risk in elderly(OR=4.26)(95%CI, 13%-28%) but no significant effect in terms of gender or time since transplant(Fig1:C-E). Conclusions: We observed a higher prevalence of dyspnea, gastrointestinal symptoms than general population. In-hospital mortality was congruent with non-transplant population with multiple co-morbidities but appeared to be less than decompensated cirrhotic patients(26-40%) as reported in literature. Further, higher mortality risk observed in elderly could be attributed to age-associated co-morbidities.
ABSTRACT
Purpose: To determine pooled prevalence of clinical outcomes among hospitalized kidney transplant recipients with COVID-19 through meta-analysis. Methods: A systematic database search between Dec1, 2019- Dec1, 2020, revealed twenty-nine studies, 875 renal transplant patients with COVID-19. Results: The most prevalent symptoms were fever(83%), cough(65%), dyspnea(46%) and gastrointestinal(27%). The frequently observed co-morbidities were hypertension(86%), DM2 (34%), and cardiac disease(26%)(Table1,2). Inhospital mortality was 23%(95%CI,17%-29%);while, it increased significantly in ICU admissions 58%(95%CI,43%-74%) (P≤0.001)(Fig1A,B). Further, subgroup analysis showed significantly increased mortality risk in elderly(OR=3.40);however, no such association was observed in terms of time since transplant and gender(Fig1C-E). Conclusions: To recapitulate, we observed a higher prevalence of dyspnea and gastrointestinal symptoms to general population. In-hospital mortality was similar to non-transplant population with high co-morbidities alongside and considered as important determinants of increased critical care admission, invasive ventilatory requirement. In-addition, observed higher mortality in elderly could be because of age-associated comorbidities. (Table Presented) .