ABSTRACT
Purpose: The increased COVID-19 severity observed in kidney transplant recipients (KTR) has been widely reported. In addition, several studies have shown a reduced humoral and cellular response after mRNA vaccination in this population compared to hemodialysis patients. However, there is currently no information on real-life clinical protection (deaths and hospitalizations), a gap that this study aims to fill. Method(s): Observational prospective study. A total population of 1336 KTR and hemodialysis patients from three dialysis units affiliated to Hospital Clinic of Barcelona, Spain, vaccinated with two doses of mRNA-1273 (Moderna) or BNT162b2 (Pfizer-BioNTech) SARS-CoV-2 mRNA vaccines. The outcomes measured were SARS-CoV-2 infection diagnosed by a positive RT-PCR fourteen days after the second vaccine dose, hospital admissions derived from infection, and a severe COVID-19 composite outcome, defined as either ICU admission, invasive and non-invasive mechanical ventilation, or death. Result(s): Six per cent (18/302) of patients on hemodialysis were infected, of whom four required hospital admission (1.3%), only one (0.3%) had severe COVID-19, and none of them died. In contrast, 4.3% (44/1034) of KTR were infected, and presented more hospital admissions (26 patients, 2.5%), severe COVID-19 (11 patients, 1.1%) or death (4 patients, 0.4%). There were no correlations on the multivariate analysis between measured outcomes and baseline characteristics nor immunosuppressive treatment. Conclusion(s): The study highlights the need for further booster doses in KTR. In contrast, the hemodialysis population appears to have an adequate clinical response to vaccination, at least up to four months from its administration.
ABSTRACT
BACKGROUND AND AIMS: Remdesivir is the only treatment that has been shown to be useful against SARS-CoV-2 infection. It shorts hospitalization time compared to placebo. Kidney transplant (KT) patients were not included in these studies, therefore, its effects in this population is limited to some published cases. METHOD: We performed a retrospective observational study that included all KT patients admitted between August 01, 2020 and November 17, 2020 with SARS-CoV-2 pneumonia who received treatment with remdesivir. Patients received a 200mg loading dose followed by 100 mg/day maintenance dose for 5 days. The objective of this study was to describe the experience of a cohort of KT patients treated with remdesivir. RESULTS: A total of 36 KT patients developed SARS-CoV-2 infection, 6 of them received treatment with remdesivir. The rest of the patients did not receive the drug due to either CKD-EPI less than 30 mL/min or they did not present clinical criteria. In addition to remdesivir, all pacients received dexamethasone and anticoagulation therapy. Immunosuppression was suspended in all patients, maintaining only dexamethasone. 50% were men, the median age was 58.5 (52.75-68) years. 67% had unknown underlying kidney disease, 83% were hypertensive and 33% had diabetes. All patients received KT from deceased brain donor and 50% received thymoglobulin as induction treatment. Median time from transplantation was 49 (20.5-135.5) months, with median glomerular filtration at admission of 47.5 (42.25-63.25) mL/min. The most frequent clinical manifestation was dry cough and dyspnea (83%), followed by tachypnea and fever (67%). Chest X-rays of all patients showed pulmonary infiltrates and required low oxygen flow therapy upon admission, requiring high flow nasal therapy in 33% of cases during admission. Only 17% of the cases presented deterioration of the graft function, not requiring hemodialysis in any case, and all recovered renal function at hospital discharge. No patient died or required admission to the critical care unit. Median days of admission was 12 (10-18) days. CONCLUSION: KT patients with SARS-CoV-2 pneumonia under treatment with remdesivir have a good clinical course, with few cases of renal function deterioration and a low mortality rate. Additional studies are necessary with a larger number of patients to improve the knowledge of remdesivir in KT with SARS-CoV-2 infection.
ABSTRACT
BACKGROUND AND AIMS: The treatment of coronavirus disease (COVID-19) is based on the patient's clinical status and levels of inflammatory biomarkers. The comparative activity of these biomarkers in KT patients with COVID-19 pneumonia from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and non-SARSCoV- 2 aetiologies is unknown. The aim of this study was to compare the clinical presentation and inflammatory parameters at admission of KT patients with COVID- 19 pneumonia and those with non-COVID-19 pneumonia over the same period. METHOD: Biomarkers were measured and compared between KT patients with COVID-19 pneumonia (n=42) and non-COVID-19 pneumonia (n=18) from March to November 2020. RESULTS: Both groups showed comparable demographics. The COVID-19 KT patients had fewer neutrophils (4,650 [2,925-9,498] vs. 9,100 [7,170-11,150],p=0.01) than the non-COVID group, although there was no significant difference in the lymphocyte count. Non-COVID-19 pneumonia was associated with a higher d-dimer (962 [427-1,448] vs. 1,704 [868-2,481],p=0.09) and IL-6 (37 [23-10] vs 254 [53- 602],p=0.006) levels. The ferritin level was higher in the COVID-19 group (908 [496- 1,377] vs. 340 [264-785],p=0.008). CONCLUSION: COVID-19 pneumonia in KT recipients shows a different presentation of inflammatory biomarkers than other non-COVID pneumonias. It could be usefully to identify KT patients with COVID-19.More detailed studies are necessary to understand the presentation of biomarkers in KT with COVID-19.
ABSTRACT
BACKGROUND: The impact of COVID-19 on the diagnosis and management of tuberculosis (TB) patients is unknown. METHODS: Participating centres completed a structured web-based survey regarding changes to TB patient management during the COVID-19 pandemic. The study also included data from participating centres on patients aged ≥18 diagnosed with TB in 2 periods: March 15 to June 30, 2020 and March 15 to June 30, 2019. Clinical variables and information about patient household contacts were retrospectively collected. RESULTS: A total of 7 (70%) TB units reported changes in their usual TB team operations. Across both periods of study, 169 patients were diagnosed with active TB (90 in 2019, 79 in 2020). Patients diagnosed in 2020 showed more frequent bilateral lesions in chest X-ray than patients diagnosed in 2019 (P = 0.004). There was a higher percentage of latent TB infection and active TB among children in households of patients diagnosed in 2020, compared with 2019 (P = 0.001). CONCLUSIONS: The COVID-19 pandemic has caused substantial changes in TB care. TB patients diagnosed during the COVID-19 pandemic showed more extended pulmonary forms. The increase in latent TB infection and active TB in children of patient households could reflect increased household transmission due to anti-COVID-19 measures.