An Audit of Demographics, Symptoms & Investigations: Part of the Survey of Gca in the Sehsct during the Covid-19 Pandemic

Background/Aims Giant cell arteritis (GCA) is the most common vasculitis in adults aged over 50 years old with the highest incidence among persons aged 70- 79. It is more commonly seen in female patients. Most cases have been reported in whites of Northern European descent. A broad range of symptoms can be reported including headache, jaw or tongue claudication, visual disturbances, PMR and other systemic features including weight loss, fever and sweats. In recent years new evidence has emerged regarding the investigation and treatment of GCA. This audit is to review the demographics, symptoms and investigations of patients who presented to the Rheumatology Department in SEHSCT with features concerning for possible GCA. Methods Retrospective collection of data from January 2020 to July 2021 using the regional Electronic Care Record NI with reference to presentations, investigation results, clinic records and follow-up letters. Results 70 patients were included (24 males and 46 females). Mean age was 72 years old. Table 1 shows the percentages of clinical symptoms reported. All patients investigated had an ESR (mean 57.8) and CRP (mean 54.1) checked. 43 patients had ANCA checked with 3 positive results. 40 patients underwent CT brain with 2 abnormalities reported unrelated to GCA. TA ultrasound was performed on one occasion with a positive result demonstrating ''halo'' sign recorded. 6 patients underwent CTPET with 3 diagnoses of LVV and 1 of PMR. 70 TAB performed with 12 positive results and 4 'suggestive' of GCA. Conclusion Our cohort of patients demonstrated demographics similar to the current global geographic trends in GCA. There are a broad range of clinical symptoms that can present in GCA, none of which are entirely specific or pathognomonic. Clinical diagnosis is based on clinical symptoms, signs and laboratory tests, each of which are imperfect markers for GCA. Our audit demonstrated that the use of additional confirmatory diagnostic tests including temporal artery ultrasound and CTPET was being under-utilized in the SEHSCT. Use of these tests may improve the diagnostic yield in this challenging condition. As a result of this audit, a quality improvement project to provide a rapid access GCA pathway is being designed. (Table Presented).

A Randomized Phase 2 Study of MAU868 vs. Placebo to Treat BK Viremia in Kidney Transplant Recipients

Background: Reactivation of BK virus (BKV) infection can cause significant kidney disease in immunocompromised patients. BKV nephropathy is a leading cause of allograft loss in kidney transplant recipients. There are currently no effective or BKV-specific therapies. MAU868 is a novel monoclonal human IgG1 that binds to the BKV major capsid protein with potent in vitro neutralizing activity against the 4 major BKV genotypes. Method(s): This is a Phase 2, randomized, placebo-controlled, double-blind study in patients (pts) who received a kidney transplant within one year. Pts had BK viremia;either >=104 copies/ml within 10 days of randomization or >=103 copies/ml in 2 consecutive samples 1-3 wks apart with most recent value measured within 10 days of randomization. Pts were randomized (2:1) to MAU868 or placebo intravenously (IV) every 28 days for 12 wks, with 24 wks follow-up. This analysis reports efficacy results at 16 and 36 wks for 2 cohorts: Cohort 1: MAU868 1350 mg IV X4 doses, and Cohort 2: MAU868 6750 mg IV followed by 1350 mg IV X3 doses. The primary endpoint was safety;BKV viral load (VL) response to treatment was assessed as secondary endpoints and post-hoc analyses. Result(s): 20 pts received MAU868 and 8 pts received placebo;all completed 12 wks of treatment and 24 wks of follow-up. Baseline characteristics were comparable between groups. Median baseline VL was 16,700 log10 BKV DNA copies/ml (range 1,200-1,800,000). MAU868 was well tolerated, with a comparable frequency of adverse events and serious adverse events between groups through wk 36. There were 2 deaths in the MAU868 group due to COVID-19 infection deemed unrelated to study drug. The antiviral effect was greater in the MAU868 group than in the placebo group at wk 16 and sustained through wk 36 (Table). Conclusion(s): MAU868 was well tolerated and demonstrated clinically meaningful BK antiviral activity in kidney transplant recipients with BK viremia. These results support the further development of MAU868 as a therapy for BK viremia. (Table Presented).

Impact of COVID on Transplant Professionalism

Purpose: Although, much has been written about COVID risk and immunization efficacy in transplant recipients, there is little data on the impact of COVID on transplant professionalism. Method(s): A survey about the impact of COVID on professional development was sent to transplant providers. There were 138 responses (10% response rate) with equal representation from transplant nephrologists, pulmonologists, surgeons, cardiologists and advanced practice providers. Responses were evenly divided between gender and across regions of the US. Result(s): 75% of respondents reported that COVID has had a negative impact on their own education with the primary reasons given being 'virtual fatigue' and not taking time off to attend virtual meetings leading to lack of engagement. 40% of respondents reported that staffing shortages made it difficult to attend virtual meetings. When asked about any positive impact of COVID on their education 43% said the ability to view sessions on their own time without travel requirements was positive. The impact of COVID on fellows' education was seen with reduced disease specific education due to focus on COVID and reduced fellow time on the wards (55% & 48% respectively).74% of respondents reported a negative impact on their professional relationships within their own center. The primary reasons were physical and emotional fatigue (43%) and staffing shortages (37%). The inability to socialize outside the work setting also had a significant impact. Fortunately, few had family or colleagues ill with COVID, but 3 reported death of co-workers or family members. Though most reported no positive impact on their work relationships (62%), "bunker mentality" and increased patience with colleagues were reported by 35%. 64% of respondents reported fatigue and lack of opportunity to see colleagues outside their own institution as a negative impact on those relationships. 76% described no positive impact on those relationships. 60% of respondents related a negative impact on their own research as there was no time to focus on research and/or most non-COVID research stopped, leading to lack of connection with research colleagues. 81% of respondents reported 'burnout' and 18% reported Post Traumatic Stress Syndrome (PTSD). When asked what the most significant impact of COVD on professionalism the overwhelming responses were emotional and physical fatigue and isolation from colleagues. The emotional stress of family and colleagues ill and sometimes dying from COVID takes a toll. Conclusion(s): In summary, in addition to the stress and physical toll the pandemic created for health care providers, transplant professionals reported a loss of ability to advance the field of transplantation due to the inability to attend professional meetings, participate in transplant-related research, and network with colleagues on topics other than COVID related care.

Post-Acute Sequelae of Sars-Cov-2 Infection in Solid Organ Transplant Recipients

Purpose: Post-acute sequelae of SARS-CoV-2 infection (PASC) is an increasingly recognized phenomenon manifested by long lasting cognitive, mental, and physical symptoms. We aimed to estimate the prevalence of PASC symptoms in solid organ transplant recipients (SOTRs) in the short (1- 6 months) and long-term (> 6 months) periods after SARS-CoV-2 infection. We also compared the prevalence of these symptoms between those with SARS-CoV-2 infection requiring hospitalization and those not requiring hospitalization. Method(s): We surveyed 111 SOTRs with self-reported SARS-CoV-2 infection diagnosed more than 4 weeks prior to survey administration. The survey consisted of 7 validated questionnaires ("Quick Dementia Rating System (QDRS)", "Patient Health Questionnaire (PHQ9)", "Generalized Anxiety Disorder 7 (GAD-7)", "Impact of Events Scale (IES-6)", "EuroQol- 5 Dimension (EQ-5D)", "PROMIS global physical health scale (GHS) "and "Breathlessness, Cough and Sputum Scale (BCSS)"). Result(s): Of the 111 survey participants, 32 (33%) had been hospitalized and 35 (36%) had SARS-CoV-2 infection >6 months ago. Median (IQR) age was 58 years (46, 65). Median time from SARS-CoV-2 diagnosis was 167 days (138, 221). Cognitive impairment, anxiety, depression, insomnia, feeling of trauma, fatigue, pain, breathing problems, cough, abnormal smell, abnormal taste, and diarrhea were reported by 40%, 23%, 36%, 55%, 53%, 41%, 19%, 33%, 33%, 21%, 22%, and 32% of patients respectively. Hospitalized patients had poorer scores in cognition (QDRS survey score of 2 versus 0.75, p=0.048) (Figure 1), quality of life (EQ-5D survey score of 2 versus 1, p=0.043), physical health (PROMIS GHS survey score of 10 versus 11, p=0.013), respiratory status (BCSS survey score of 1 versus 0, p=0.056), and pain (Pain score of 3 versus 0, p 0.006). Among patients who had SARS-CoV-2 infection >6 months ago, abnormal breathing, cough, abnormal smell, abnormal taste, and diarrhea continued to be reported by 31%, 31%, 29%, 32%, and 32% of patients respectively. Conclusion(s): After SARS-CoV-2 infection, SOTRs had a high prevalence of PASC symptoms. Some of the symptoms are more severe in patients who had required hospitalization and persist beyond 6 months. Further studies are needed to understand the long term sequalae of SARS-CoV-2 infection in SOTRs and to develop an evidence-based multidisciplinary approach for caring for these patients beyond the acute phase. (Table Presented).

COVID-19 outcomes in solid organ transplant patients given tixagevimab-cilgavimab prophylaxis and/or bebtelovimab treatment in a nurse-led program

Background: Incidence of COVID-19 Omicron infection in SOTR is high, but there are few data on interventions after BA.1. Tixagevimab- cilgavimab (TC) was available for pre-exposure prophylaxis (ppx) as of 1/2022: and bebtelovimab (BEB) as treatment in 4/2022 with the rise of BA.2. Aims: We aimed to describe Omicron outcomes in SOTR at a single US center through 7/9/22, focusing on TC (ppx) and BEB (treatment). Methods: Candidates for TC were identified by electronic medical record (EMR), referrals, and RN outreach. EMR eports of positive SARS-COV-2 tests in SOTR were generated daily. NPs and RNs helped arrange BEB for those who met criteria. Results: 213 SOTR received TC (197 got 300/300mg), and 22(10.3%) developed COVID-19;3 were hospitalized, 1 required mechanical ventilation (MV), 2 died (one with BA-1). 4 (18.2%) cases were <14 days after TC. 7 (3.3%) patients had cardiac events, with median time of 13 weeks post TC. 212 SOTR were diagnosed with COVID-19 from 4/4/22-7/9/22 (127 kidney, 30 liver, 18 lung, 27 heart, 10 dual). 145 (68.4%) were treated with BEB;of those, 18 (12.4%) were hospitalized, 1 required MV, and 1 (0.7%) died. Conclusions: Despite large numbers of Omicron cases, almost 90% of SOTR who received TC did not contract COVID-19;of the 10.3% who did, most had mild disease and 2 died. 7 cardiac events were reported after TC, but relationship to TC is unclear. SOTR with COVID-19 who received BEB had low rates of hospitalization and 1 death. These favorable outcomes underscore the value of an RN-led program for rapid referral for monoclonal antibody ppx or treatment.

Nurse and nurse practitioner-lead monoclonal antibody initiative for solid organ transplant (SOT) recipients with COVID-19

Purpose: Monoclonal antibody (mAB) infusion (bamlanivimab or casirivimab/ imdevimab) for symptomatic, non-hypoxemic, high-risk outpatients with COVID-19 infection, is an available early intervention for COVID-19+ SOT recipients. We aimed to assess efficiency in time from diagnosis to treatment, and outcomes in a retrospective cohort of SOT recipients with COVID-19 who received mAB. Methods: We developed a Nurse Coordinator-led initiative to screen, refer, and facilitate mAB infusion for COVID-19+ SOT recipients within 10 days of symptom onset. SOT recipients received electronic messaging to promptly report potential COVID-19 symptoms to the transplant team. Data were collected on time from symptom onset to diagnosis, mAB infusion, and follow-up > 21 days, and hospital admissions, disease severity, mortality, and rejection. Results: 34 out of 36 referred SOT recipients with symptomatic COVID-19 disease without hypoxia received mAB therapy (3 heart, 8 lung, 16 kidney, 2 Liver-Kidney, 2 Pancreas-Kidney, 3 Kidney-Heart). Median time from symptom onset to diagnosis was 2 days and from date of diagnosis to mAB infusion was 4 days. Of those 34, 88% did not require hospitalization and recovered uneventfully. 12% required hospitalization for COVID disease progression, two on the same day as mAB infusion, and the other 2, more than 26 days post infusion. Of these, 2 patients had mild-moderate hypoxia, and 2 had critical disease. Only 1 patient died from COVID-19 complications and no episodes of rejection or graft loss were observed. Conclusions: The Nurse Coordinator-led initiative efficiently facilitated mAB therapy for COVID-19+ SOT recipients and was associated with excellent outcomes. Compared to prior published COVID-19 outcomes in SOT recipients, patients who received mAB may have reduce hospitalization and low mortality. As mAB therapy may be underutilized in the general population, these results support efforts to educate transplant centers to implement efficient interventions for the screening and referral of COVID+ SOT recipients for mAB therapy.

Comparison of outcomes in sot recipients during two eras of covid-19 therapeutics

Purpose: COVID-19 therapies have evolved over time, but little is known regarding outcomes in SOT recipients treated with newer therapeutic agents such as remdesivir, dexamethasone, and convalescent plasma. We sought to compare outcomes including mortality, rejection, and renal function in a retrospective cohort of SOT recipients with COVID-19 treated during two different eras of therapy. Methods: 40 SOT recipients hospitalized for COVID-19 at our center comprised Era 1 (Mar-May 2020, 20 patients) and Era 2 (Jun-Aug 2020, 20 patients). Data were collected on demographics, comorbidities, renal function, and mortality at time points out to 90 days after COVID-19 infection. Results: Patients in Era 1 received hydroxychloroquine (11/20, 55%), tocilizumab (5/20, 25%) and/or convalescent plasma (3/20, 15%) as targeted therapy;patients in Era 2 received primarily remdesivir (8/20, 40%), dexamethasone (6/20, 30%), and/or convalescent plasma (13/20, 65%). Mortality was 1/20 in Era 1 and 0/20 in Era 2. MMF was held in 33/35 (94%) of patients. Acute kidney injury was present on presentation in 14/40 (35%). The median (IQR) decrease in SCr (mg/dl) between admission and last followup was 0.5 (0.4-0.6) and 0.1 (0-0.4) in patients who had and had not received remdesivir, respectively (p=0.02), 0.5 (0.1-0.6) and 0.1 (0-0.3) in patients who had and had not received plasma, respectively (p=0.09). Antibodymediated rejection (AMR) occurred in 2 patients in Era 1 and 0 patients in Era 2. Acute cellular rejection (ACR) occurred in 1 patient in Era 1 and 0 patients in Era 2. Conclusions: SOT recipients treated in Era 2, when the major targeted therapies were remdesivir, dexamethasone, and convalescent plasma, were not at higher risk for renal dysfunction, ACR, or AMR in the aftermath of COVID-19;rejection was uncommon in both eras and mortality was low in both eras. While awaiting detailed safety studies, these results suggest against renal toxicity or triggering of alloimunity in those receiving newer therapies.

Living well with and beyond cancer: a digital exploration of patient experience and expertise in Ireland

Introduction/Background*The Living Well Cancer Programme is an Irish Cancer Society funded pilot programme aimed at developing a survivorship service for women survivors of cancer.A key element of this programme is public and patient involvement (PPI) in our efforts. With this in mind, we established a digital advisory board through a company called medCrowd to ascertain the opinions and experiences of our patients to guide development of this pilot service.Methodology16 patient representatives were selected from those attending the follow-up and surveillance programme at both clinical sites in Dublin. Participants were selected based on cancer site and treatment modalities experienced. Participants were given access to a secure site on the medCrowd platform, and 5 questions were posed to them over the course of 6 weeks in early 2021. The 5 questions focused on (1)what a survivorship service should offer, (2)what resources would participants recommend, (3)what advice would participants give to a newly diagnosed person, (4)what would a successful service look like and (5)what were the participants views on virtual follow up post COVID-19. Responses were text-based.Result(s)*Of the 16 participants selected, 14 engaged in the process. The overall response rate for all questions was 71% with 94 individual messages sent over the conversations.Participants identified that patient needs for survivorship depend on disease site, stage and treatment modalities and do change over time. Nevertheless, they identified areas such as sexual dysfunction, fertility, peer support groups, career and financial advice as essential for any survivorship service to address. All participants spoke of the need for a designated contact person on their medical team whom they can contact with ‘minor’ queries. The need for psychological support both formal and informal was also highlighted. Participants also spoke about their own unmet needs and a need to increase supports around the issues of menopause, exercise, nutrition and fatigue management.Participants also felt there were aspects of a survivorship service which could be offered virtually, however, all would prefer some face-to-face contact with their treating team.Conclusion*The information provided through this digital advisory board will now inform the work of the Living Well Cancer Programme.

Robotics, digital twins and AI: Connecting the dot matrix

Robotics is often referred to as an enabler towards safer and more cost-effective operations within the energy industry. However, for robots to achieve their full potential they too require their own enablers. This paper intends to present a collection of lessons learnt in robotic development to date that has resulted in the necessity to develop an encompassing digital architecture. This architecture, with an artificial intelligence component, has been designed to optimise both robot and digital twin capability, where the complete system is always working with the latest information available that reflects the ground truth. The architecture concept will be explained including why integration and standardisation are of paramount importance. The paper will also demonstrate how business value can be generated before fully explainable, transparent, verifiable autonomy is available for robotics to be deployed on future unmanned platforms that have been designed to optimise robot operation opposed to existing human engineered environments. All these topics are important within their own right, but all are also years away from adoption on an industrial scale. To ensure continued engagement until such a point is reached, the industry needs to focus more on the quick wins and immediate value that can be gained from robotics. The impact of COVID-19 has shown how quickly and effectively the energy industry has been able to transition to remote working. This represents a massive opportunity to prove what robotics can deliver via remote operation, minimizing vendors where possible. The concept of "full" autonomy will be discussed with respect to value generation and barrier to entry or adoption within the energy industry. The paper will address all practical considerations that have required attention to date plus explain the next programme of work in the evolving RAS (robotics and autonomous systems) digital architecture whilst ensuring complete integration with the data pipelines that have already been built. © 2021, Society of Petroleum Engineers

Awareness of internet-based testing for sexually-transmitted and blood-borne infections among sexual minority men in British Columbia, Canada

BackgroundGetCheckedOnline is an internet-based testing program for HIV, Hepatitis C, and other sexually-transmitted infections (STIs) in British Columbia (BC), Canada. The program launched in 2014 in Vancouver, BC’s largest urban centre, and expanded to six smaller urban and suburban BC communities in 2016. We sought to measure GetCheckedOnline awareness among gay, bisexual, and other men who have sex with men (gbMSM), and to identify characteristics that may contribute to program awareness.MethodsSex Now was a cross-sectional online health survey of Canadian gbMSM aged ≥15 years recruited from 10/2019–02/2020. BC residents were asked if they knew about GetCheckedOnline and additional questions related to implementation outcomes. We built a multivariable logistic regression model including all variables significant in univariate analysis to quantify associations with awareness, and report adjusted odds ratios and 95% confidence intervals (AOR [95%CI]).ResultsAmong participants living in regions where GetCheckedOnline is available (n=1132, median age: 36 years), 38.1% were aware of GetCheckedOnline. Greater GetCheckedOnline awareness was associated with living outside of Vancouver (AOR=2.15 [1.50–3.10]), identifying as queer (AOR=1.58 [1.13–2.21]), having post-graduate education (AOR=1.84 [1.17–2.91]), being out to healthcare providers (AOR=1.97 [1.22–3.24]), using ≥3 geolocation-based sex-seeking apps (AOR=2.15 [1.40–3.33]), and past-year involvement in LGBTQ2S+-specific activities (AOR=1.56 [1.10–2.23]). Awareness decreased with increasing years of age (AOR=0.98 [0.97–1.00]). Compared with participants who usually tested for STIs at a sexual health clinic, awareness was lower among participants who usually tested for STIs through their family doctor (AOR=0.50 [0.33–0.73]) or at walk-in medical clinics (AOR=0.54 [0.30–0.96]), and among those who had never tested for STIs previously (AOR=0.17 [0.06–0.39]).ConclusionAlmost 40% of gbMSM in our sample were aware of GetCheckedOnline. Increasing promotion to gbMSM who are not out to their healthcare provider, who have never tested previously for STIs, or who are less connected to LGBTQ2S+ communities may improve program reach.

Cytoreductive surgery (Crs) and hyperthermic intraperitoneal chemotherapy (hipec) for peritoneal malignancy during the covid-19 pandemic

Aim COVID-19 has instigated rapid alterations in surgical care. Performing CRS-HIPEC for peritoneal metastases during such challenging times has required several perioperative changes. We report our early experience of undertaking CRS-HIPEC during the COVID-19 pandemic. Methods A retrospective review of all patients undergoing CRS-HIPEC was conducted (1st April/20 – 28th May/20). Data was retrieved from a prospectively maintained peritoneal malignancy database. Results Twelve patients (M:F, 5:7;median, 56yr (26-70yr)) underwent CRS-HIPEC. Five patients had peritoneal metastases of colorectal origin, with a median peritoneal-carcinomatosis-index (PCI) of 12, while four patients had advanced pseudomyxoma peritonei (median, PCI 23). Patients were pre-operatively assessed for SARS-CoV-2. Operating theatres (OT) with laminar-air-flow-systems and high-efficiency-particulate-air-filters were utilized. Essential personnel were permitted through a one-way entry/exit pathway. Double plume extractors were used to remove surgical smoke throughout the operation. HIPEC was conducted using the closed rather than open abdomen technique. Patients were transferred via a modified critical care pathway to HDU. Early results have identified no significant COVID-related complications. Conclusion Initial experience of surgery for peritoneal malignancy in the COVID-19 era is encouraging. We will continue to carefully audit our perioperative outcomes as our experience builds.

Surgical morbidity during covid-19 pandemic-a gynaecology oncology persective

Introduction COVID-19 has had significant repercussions on the provision of oncological surgical services worldwide. Within any Gynaecological Oncology service, careful consideration needs to be given when weighing up peri-operative risks & potential inpatient exposure to COVID-19 versus the risk of delaying surgery. Often, for these patients, deferral of surgery may result in disease progression. Since March 2020, we identified 118 Gynaecological Oncology patients referred to the Ireland East Gynaecological Group between the Mater Misericordiae University Hospital (MMUH) & St. Vincent's University Hospital (SVUH) for whom major oncological surgery was deemed clinically urgent. To minimise peri-operative morbidity and the risk of onward hospital transmission of COVID-19, screening questionnaires were administered before hospital admission. These screened for epidemiological risk, symptoms, recent travel & contacts. If asymptomatic, testing for SARS-CoV-2 was not performed. Methods We analysed the clinical data of the above 118 patients to determine their baseline characteristics/risk factors for COVID-19, suspected diagnoses, surgical procedures & 7- day morbidity. Results This cohort consisted of ovarian (n=57), endometrial (n=41), cervical (n=6) and vulvo-vaginal (n=14) cancer patients. 44% of cases were laparoscopic and 18% were major cytoreductive surgeries. All patients screened were deemed asymptomatic & low risk- therefore proceeded to surgery. 49 (41.5%) patients had a defined risk factor for COVID-19. 7- day post-operative morbidity was 13% (N=16). 3 patients met symptomatic criteria for COVID-19 testing post-operatively, however none tested positive. Conclusion Careful patient selection based on risk factors and symptoms allows units to continue to perform safe oncological surgery during a pandemic.

Identifying scenarios of benefit or harm from kidney transplantation during the COVID-19 pandemic: A simulation study

Background: Clinical decision-making in kidney transplantation (KT) during the COVID-19 pandemic is a challenge: both candidates and recipients may face increased acquisition risks and case fatality rates (CFRs). Given our poor understanding of these risks, many centers have paused or reduced KT activity, yet data to inform such decisions are lacking. Methods: To quantify the benefit/harm of KT in this context, we conducted a Markov simulation study of immediate-KT vs delay-until-after-pandemic for different patient phenotypes under a variety of potential COVID-19 scenarios (Figure 1), simulating expected life-months gained from transplant over 5 years. A calculator was implemented (http://www.transplantmodels.com/covid-sim), and machine learning approaches were used to evaluate the important aspects of our modeling. Results: Characteristics of the pandemic (acquisition risk, CFR) and length of delay (length of pandemic, waitlist priority for DDKT) had greatest influence on benefit/ harm (Figure 2). In most scenarios of COVID-19 dynamics and patient characteristics, immediate-KT provided survival benefit;KT only began showing evidence of harm in scenarios where CFRs were substantially higher for KT recipients (e.g. ≥50% fatality) than for waitlist registrants. Conclusions: Our simulations suggest that KT remains beneficial under COVID-19 in many scenarios. Our calculator can help identify patients who would benefit most. As the pandemic evolves, our calculator can update these predictions.

Telemedicine in the care of kidney transplant recipients with COVID-19

Introduction: Kidney transplant (KT) recipients with COVID-19 symptoms are bringing challenges to providers given the risk of COVID-19 exposure to health care workers, patients, and the public. Case Description: Three KT recipients with COVID-19 were managed using telemedicine via synchronous video visits integrated with an electronic medical records system, from home to inpatient settings (Figure 1-2). Patient 1 is a 53-year-old male s/p KT in 2012;Patient 2 is a 56-year-old female s/p KT in 2019;and Patient 3 is a 53-yearold female s/p simultaneous liver-kidney transplant in 2014. Patients 1 and 3 had followup COVID-19 NAT testing: Patient 1 converted to be negative at 24 & 28 days, whereas Patient 2 converted to be negative at 45 & 48 days. Discussion: Telemedicine helped assess, diagnose, triage, and treat patients with COVID-19 while avoiding an ER or outpatient clinic visit. We highlight the value of telemedicine in the maintenance of uninterrupted follow-up care for immunosupressed patients with prolong viral shedding.