ABSTRACT
A low anti-spike antibody response of 28.6% was observed 28 days after BNT162b2 vaccine second dose among 133 solid organ transplant recipients without previous coronavirus disease 2019 (COVID-19). No serious adverse events were recorded. Four severe COVID-19 cases were reported between or after the 2 doses. Our data suggest to change the vaccine strategy.
Subject(s)
COVID-19 , SARS-CoV-2 , Antibodies, Viral , Antibody Formation , BNT162 Vaccine , COVID-19/prevention & control , COVID-19 Vaccines , Humans , Transplant RecipientsSubject(s)
COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Organ Transplantation , Purpura, Thrombotic Thrombocytopenic/etiology , SARS-CoV-2/immunology , Tissue Donors , Aged , COVID-19/immunology , COVID-19/virology , COVID-19 Vaccines/administration & dosage , ChAdOx1 nCoV-19 , Donor Selection , Fatal Outcome , Female , Humans , Male , Middle Aged , Organ Transplantation/adverse effects , Risk Assessment , Risk Factors , Treatment Outcome , Vaccination/adverse effectsABSTRACT
BACKGROUND: Notwithstanding the ongoing coronavirus disease-2019 (Covid-19) pandemic, information on its clinical presentation and prognosis in organ transplant recipients remains limited. The aim of this registry-based observational study was to report the characteristics and clinical outcomes of liver transplant (LT) recipients included in the French nationwide Registry of Solid Organ Transplant Recipients with Covid-19. METHODS: COVID-19 was diagnosed in patients who had a positive PCR assay for SARS-CoV-2 or in presence of typical lung lesions on imaging or specific SARS-CoV-2 antibodies. Clinical and laboratory characteristics, management of immunosuppression, treatment for Covid-19, and clinical outcomes (hospitalization, admission to intensive care unit, mechanical ventilation, or death) were recorded. RESULTS: Of the 104 patients, 67 were admitted to hospital and 37 were managed at home (including all 13 children). Hospitalized patients had a median age of 65.2 years (IQR: 58.1â¯-â¯73.2 years) and two thirds were men. Most common comorbidities included overweight (67.3%), hypertension (61.2%), diabetes (50.7%), cardiovascular disease (20.9%) and respiratory disease (16.4%). SARS-CoV-2 infection was identified after a median of 92.8 months (IQR: 40.1â¯-â¯194.7 months) from LT. During hospitalization, antimetabolites, mTOR inhibitor, and CNIs were withdrawn in 41.9%, 30.0% and 12.5% of patients, respectively. The composite endpoint of severe Covid-19 within 30 days after diagnosis was reached by 33.0% of the adult patients. The 30-day mortality rate was 20.0%, and 28.1% for hospitalized patients. Multivariate analysis identified that age was independently associated with mortality. CONCLUSION: In our large nationwide study, Covid-19 in LT recipients was associated with a high mortality rate.
Subject(s)
COVID-19/epidemiology , Liver Transplantation/statistics & numerical data , Pandemics , Registries/statistics & numerical data , Transplant Recipients/statistics & numerical data , Adolescent , Aged , COVID-19/diagnosis , COVID-19/mortality , COVID-19/therapy , COVID-19 Nucleic Acid Testing , Child , Comorbidity , Female , France/epidemiology , Hospitalization/statistics & numerical data , Humans , Immunosuppression Therapy , Intensive Care Units , Liver Transplantation/mortality , Male , Middle Aged , Respiration, Artificial/statistics & numerical data , Risk FactorsABSTRACT
BACKGROUND: Coronavirus disease (COVID) is a new and highly contagious infectious disease caused by the coronavirus (COVID-19 or severe acute respiratory syndrome coronavirus 2). There is limited data regarding the incidence and management of COVID-19 in immunocompromised patients' post-transplantation. In the pre-COVID-19 era, these patients were already at an increased risk of developing opportunistic infections. These often manifested with atypical symptoms. CASE SUMMARY: We report another case of uneventful COVID-19 pneumonia in a 58-year old male who was 18 mo' post liver transplantation. He received tacrolimus monotherapy since July 2019. The clinical manifestations included only epigastric pain radiating to the right hypochondrium, nausea and vomiting. He had no fevers, cough, shortness of breath, anosmia or dysgeusia even if the chest computed tomography scan revealed an extension of the multiple patchy ground-glass density shadows to the upper lobe of the left lung too. He was hospitalised and received a course of oral chloroquine (200 mg × 3 per day) for a period of 10 d. Interestingly, the COVID 19 infection was uneventful though there were no modifications to his tacrolimus dosing. He was successfully discharged. We performed subsequent follow-up via telemedicine. CONCLUSION: In light of the current pandemic, it is even more important to identify how the liver recipient's patients present and are managed, especially for immunosuppression treatment.
Subject(s)
COVID-19/diagnosis , Graft Rejection/prevention & control , Immunosuppression Therapy/methods , Liver Transplantation/adverse effects , SARS-CoV-2/immunology , COVID-19/immunology , COVID-19/prevention & control , COVID-19/virology , Graft Rejection/immunology , Humans , Immunocompromised Host , Lung/diagnostic imaging , Lung/immunology , Lung/virology , Male , Middle Aged , SARS-CoV-2/isolation & purification , Severity of Illness Index , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: The global pandemic of Coronavirus Disease 2019 (COVID-19) has potentially affected liver transplantation (LT) programs worldwide. The aim of this study was to determine whether the COVID-19 outbreak affected organ donation and LT activity in France. METHODS: Data on the number of brain-dead donor procurements and adult liver transplantations were compared between two periods (1st January- 31st May 2019 vs. 1st January-31st May 2020). MAIN FINDINGS: There was a 28% decrease in the number of organ donations in 2020 (543 in 2020vs. 752 organ donations in 2019). A 22% decrease in the number of liver transplantations was also observed: 435 in 2020 vs. 556 LTs in 2019. Overall, the North East area which was the main COVID-19 cluster area, had > 25% decrease of the multiorgan procurement (-33% compared to 2019), and liver transplantation (-26% compared to 2019) activities in 2020 CONCLUSION: This analysis confirmed that during the COVID-19 outbreak there was a significant decrease in the number of organ donations and liver transplantations performed in France.