Subject(s)
Ambulatory Care/methods , COVID-19/prevention & control , Kidney Transplantation , Physical Distancing , Postoperative Care/methods , Telemedicine/methods , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Female , Humans , Male , Middle Aged , New York City/epidemiology , Outcome and Process Assessment, Health Care , PandemicsABSTRACT
Coronavirus disease 2019 (COVID-19) has become a pandemic since first being described in January 2020. Clinical manifestations in non-transplant patients range from asymptomatic infection to severe pneumonia with acute respiratory distress syndrome, multiorgan system failure, and death. Limited reports in kidney transplant recipients suggest similar characteristics in that population. We report here the first case series of COVID-19 infection occurring in pancreas transplant recipients.
Subject(s)
COVID-19/therapy , Kidney Transplantation , Pancreas Transplantation , Telemedicine , Adult , Ambulatory Care , COVID-19/immunology , COVID-19/physiopathology , Deprescriptions , Diabetes Mellitus, Type 1/surgery , Diabetic Nephropathies/surgery , Female , Graft Rejection/prevention & control , Hospitalization , Humans , Immunosuppressive Agents/therapeutic use , Kidney Failure, Chronic/surgery , Male , Middle Aged , Respiratory Insufficiency/physiopathology , SARS-CoV-2ABSTRACT
Solid organ transplant recipients may be at a high risk for SARS-CoV-2 infection and poor associated outcomes. We herein report our initial experience with solid organ transplant recipients with SARS-CoV-2 infection at two centers during the first 3 weeks of the outbreak in New York City. Baseline characteristics, clinical presentation, antiviral and immunosuppressive management were compared between patients with mild/moderate and severe disease (defined as ICU admission, intubation or death). Ninety patients were analyzed with a median age of 57 years. Forty-six were kidney recipients, 17 lung, 13 liver, 9 heart, and 5 dual-organ transplants. The most common presenting symptoms were fever (70%), cough (59%), and dyspnea (43%). Twenty-two (24%) had mild, 41 (46%) moderate, and 27 (30%) severe disease. Among the 68 hospitalized patients, 12% required non-rebreather and 35% required intubation. 91% received hydroxychloroquine, 66% azithromycin, 3% remdesivir, 21% tocilizumab, and 24% bolus steroids. Sixteen patients died (18% overall, 24% of hospitalized, 52% of ICU) and 37 (54%) were discharged. In this initial cohort, transplant recipients with COVID-19 appear to have more severe outcomes, although testing limitations likely led to undercounting of mild/asymptomatic cases. As this outbreak unfolds, COVID-19 has the potential to severely impact solid organ transplant recipients.